Leg Ulcers
The term"leg ulcer" refers to a poorly healing wound on the lower leg.
The cause of leg ulcers is poor circulation of the tissue due to disease changes in the arterial supply and / or venous drainage. Roughly 90 % of all leg ulcers are attributable to this cause.
A venous leg ulcer is a complication of a chronic venous insufficiency resulting generally from changes secondary to a deep thrombo-phlebitis or varicose of superficial, perforans and / or deep veins.
Intact valves
The venous system is made up of superficial and deep veins. Superficial veins are located between the skin and the muscles, deep veins are located between the muscles and both are connected to each other by perforans veins. All of these veins have valves which normally ensure that blood flows from the superficial veins to the deep system. If the valves are incompetent (varicose veins) or damaged (e.g. postphlebitic syndrome), venous insufficiency may occur allowing blood to flow backwards and stagnate (pool) in the veins of the lower legs. This in turn increases the blood pressure in the legs and causes a leakage of fluid from the veins into the tissue with subsequent tissue edema. The edematous skin area can break down and eventually a visible ulcer can develop on the skin.
Incompetent valves
Before initiating any treatment, it is crucial that the correct etiology of the leg ulcer is identified, e.g. arterial versus venous ulcer, since inappropriate application of compression therapy to an ischemic limb (arterial ulcer) would have a deleterious effect. Venous leg ulcers appear mostly on the medial aspect of the lower leg, just below the ankle. In contrast to arterial ulcers, venous leg ulcers are generally large and do have irregular margins. The skin surrounding is often hyperpigmented.
Beside moist wound treatment, the basic care for a patient with a venous leg ulcer should include compression bandaging, elevation of the affected leg and – if possible - mobilization.
