Introduction:
A leg ulcer does not heal because the veins in the legs are not working as they should, and this condition is known as venous hypertension, also called venous disease, venous insufficiency, or venous reflux. Chronic venous insufficiency can affect the superficial venous network of the lower limbs presenting as superficial venous reflux, which causes varicose veins and venous leg ulcerations. Venous leg ulcers are the most common cause of leg ulceration and are usually estimated to be around 65 % of the leg ulcer population. There are three main types of leg ulcers: venous, arterial, and neuropathic. There are other ulcers also present, such as pressure ulcers, trauma, infection, pyoderma gangrenosum, vasculitis, skin cancer, etc. Leg ulcers can also be categorized in terms of acute and chronic. Acute leg ulcers can be present in less than six weeks, and chronic leg ulcers are present for more than six weeks.
What Causes Leg Ulcers?
The most common cause of a leg ulcer is a problem with the veins. In circulation, the heart pumps out blood into the arteries, which go to the body and come back through the veins. In ordinary people, that blood flows back when they walk, but in the case of leg ulcers, the blood does not flow back correctly. This dysfunction in the blood flow can be due to several reasons, like in case the valves are not working correctly and the blood reflux is flowing back down to the legs causing damage to the ankles. The second common reason is that some people do not move correctly enough and sit in an idle position for long periods of time, or someone can be paralyzed or unwell making them unable to move, which makes the blood sit in the leg and does not get pumped back to the heart. Another reason is narrowing or blockage in one of the major veins in the pelvis or leg.
What Is the Etiology of Different Leg Ulcers?
The following explains the etiology of the leg ulcers-
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In the Case of Venous Leg Ulcers- It can be due to valve dysfunction, stasis of the blood, fibrin leak, red cell extravasation, hemosiderin deposition, damage of superficial lymphatics, etc.
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In the Case of Arterial Leg Ulcers- It can be due to ischemia, large vessel disease, vasculitis, scar tissue compression, trauma, etc.
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In the Case of Neuropathic Leg Ulcers- This can be due to sensory neuropathy trauma, motor neuropathy, diabetes, malnutrition, etc.
What Do Leg Ulcers Look Like Clinically?
Leg ulcers usually appear as swollen red skin with leakage of fluids from the affected area; they are described thoroughly below-
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Venous Ulcers- They are present with the patient's history of obesity, immobility, and varicose veins and can be seen as pigmented, hot, and swollen in the medial aspect of the legs. These ulcers can be very large and painful.
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Arterial Ulcers- They are present with the patient's history of intermittent claudication, diabetes, smoking, etc., and appear shiny, hairless, cold, pale skin in the lateral malleolus, toes, and dorsum of the foot. These ulcers are usually small but are painful.
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Neuropathic Ulcers- They are present with the patient's history of diabetes, numbness, and a family history of leg ulcers. They are present in the heel, metatarsal head, and pressure points and are usually small and painless.
How Can Leg Ulcers Impact People?
Leg ulcers are a severe type of infection that can affect a person’s physical health as well as social well-being, such as.
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Pain.
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The smell from the leg.
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Leakage from the ulcered area.
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Impaired mobility.
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Anxiety or depression.
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Sleep disturbance.
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Social isolation.
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Financial impact.
What Are the Treatment Options?
With appropriate therapy, about three-quarters of people with venous leg ulcers should heal within 12 months, although about two third should heal within six months. Studies have shown that surgical correction of superficial venous reflux by endovenous laser therapy can reduce venous leg ulcer recurrence more than compression therapy alone. A compression bandage is applied to dry out the leakage from the wound. Emollients and steroid creams are applied to the area for healing, and the site is debrided to promote the formation of new tissues. In case of a blocked vein, a stent can be inserted. In severe cases, grafting or angioplasty can be done by a vascular surgeon.
How to Manage Leg Ulcers in Older People?
It is important to note that healing can take weeks to months, and during that period, older person’s impaired mobility and social isolation should be addressed properly as they are more sensitive in terms of physical and mental well-being. The following things can be done to manage leg ulcers-
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A robust, holistic leg ulcer assessment by considering the patient’s experience, patient education about the condition, and flexible approach to treatment options.
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A correct diagnosis of the cause of the infection.
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Pain management by addressing the cause of the pain and administration of analgesics.
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Skin care includes removal of hyperkeratosis, skin cleansing with bowl water or showering, treatment of skin infections, emollient therapy, maintenance of pre-wound skin, hydration, etc.
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Wound care by removing devitalized tissue and managing infection to protect new granulation tissues.
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A compression bandage is applied to the affected area to dry out the slough, and a firm compression needs to be used correctly.
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Leg elevation should be appropriately taught to elderly patients.
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Good nutrition through diet should be given to the patient.
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Smoking cessation if present.
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A reassessment of the treatment plan should be done during each visit by the physician.
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Early referral to decrease the chances of infection spreading.
Conclusion:
It is essential to educate the older patient about venous disease, the role of compression therapy in treatment and prevention, and health advice in regard to leg elevation, foot exercises, sleep, hygiene, and pain management. Leg ulcers are a serious type of infection and should be treated as early as possible to avoid further complications, and they should be addressed to the right specialist.
