The skin is the largest organ in our body and acts as a barrier that protects us from outside contaminants and maintains our body’s normal temperature. When the skin breaks around our ankles as a result of an injury and or an underlying medical condition, a leg ulcer may form. The protective function of the skin is then disrupted allowing air and bacteria to get into the underlying tissues. If an ulcer forms, the body will quickly mount a defense and act to heal an open wound, usually over a period of two to four weeks (acute wound), some wounds do not heal rapidly and are called chronic wounds after four weeks. A chronic wound requires expert care. At South Charlotte General and Vascular Surgery, our wound experts will not only diagnose the underlying reason for the delay in the healing process, but also formulate an appropriate wound care plan that will help you heal your wound in the shortest period of time possible.
What causes leg ulcers?
Our vascular and wound experts will take a complete history and perform a detailed physical exam to help identify the cause, the stage of the ulcer, and any underlying medical condition, which is interfering with your ability to heal. When your ulcer does not heal, one or more of the following conditions may be the cause:
- Poor circulation
- Increased pressure in the legs
- Increased pressure on the area of the ulcer
Chronic leg ulcers are commonly defined as one of four types:
1. Venous ulcers. Initially swelling occurs, but over time, the skin starts undergoing changes that may interfere with the healing process. It gets thicker, develops a brown pigmentation and has a leathery appearance. These ulcers are commonly seen on the inner aspect of the ankle extending up to the middle part of your leg and occasionally extending to the outer part of your leg. They are superficial, usually not painful unless touched and are associated with swelling in most patients and have a tendency to weep.
2. Arterial ulcers: (15%) are caused by a lack of good arterial blood flow, which often results from significant blockages or plaque build-up in your arteries. The lack of blood flow to the tissues, particularly in the area of the skin breakdown, will deprive the wound from the oxygen and nutrients needed to heal. This is more common in patients with PAD (Peripheral Arterial Occlusive Disease), Type II Diabetes mellitus and/or chronic kidney problems.
3. Pressure ulcers: (10%) are caused by direct and persistent pressure to an area of the skin resulting from prolonged bed rest or sitting. These ulcers are often seen in chronically ill patients and occur over bony prominences, particularly in the heels and buttock areas. These may also be associated to a lack of good arterial blood flow.
4. Others causes: (5%) some ulcers are caused by ongoing inflammation e.g. arthritis, skin cancer or auto-immune conditions. They tend to be small and often present as single or multiple ulcers spread out on the legs. Medications can also cause ulcers in some patients even if they had been on it for a while.
It is important to note that, in some cases, two or more conditions may be interfering with the healing process at the same time. At the South Charlotte General & Vascular Surgery’s Vascular and Vein Center our wound experts will examine you and determine what type of ulcer you have so the correct treatment can be applied. Our highly trained ultrasound technologists will perform non-invasive tests in a comfortable and serene environment in our office to determine the quality of your vascular system and help guide us in planning the precise treatment you require.
How will I be treated?
The treatment of a chronic leg ulcer depends on a number of factors:
- Age of the patient
- Type of ulcer
- Any associated medical conditions
- Arterial insufficiency
- Venous insufficiency
General guidelines for treating ulcers:
- Venous ulcers: the mainstay of treatment is to eliminate the venous pooling and elevated venous pressure. A treatment plan would include treating the wound itself with special creams, treating the surrounding skin with moisturizing agents, and applying compression bandaging to decrease the venous pressure. In the patients who have superficial venous reflux, treating the veins that are leaking will eliminate the pressure and restore the ability of the skin to heal. In select patients who do not respond to conservative measures, using a skin substitute and special wound V.A.C. may significantly facilitate the healing time.
- Arterial ulcers: require more aggressive intervention as they tend to occur late in patients with peripheral arterial disease or in patients with uncontrolled sugars or failing kidneys. They often require testing with ultrasound and may even require catheterization to localize the blockage and address it in order to avoid deterioration of the wound and resolve the pain (see: PAD)
- Pressure ulcers; typically respond to elimination of pressure and appropriate wound care unless an arterial or venous component is present as well.
How long will it take the ulcer to heal?
The healing process in chronic wounds is delayed and may not occur until the underlying problem is addressed. The changes that led to the ulcer formation occurred over years so it is not surprising that ulcers may take a fairly long time to heal. In venous ulcers, it usually takes 2-3 months. Arterial ulcers may actually worsen quickly unless the blood flow is restored, and infection is resolved. Once the wound gets adequate oxygen and nutrients, the wound will start healing rapidly. Pressure ulcers take time to heal and unfortunately are prone to reoccur if patients are immobilized.
Don't despair! Even in these resistant cases, healing will occur with time.
How can I stop the ulcer coming back?
Once your ulcer is healed, it does not mean that your problems are over. Although the skin is intact, the underlying problem may still be present, and patients may be prone to having a recurrent ulcer. Taking precautions to prevent the ulcer from recurring is an essential component of the treatment plan and adequate follow-up.
At South Charlotte General and Vascular Surgery, we are committed to protecting your legs and preserving your lifestyle.
To book an appointment with one of our wound experts, please give us a call or complete our appointment request form.