Q. Why is my wound not getting cured?

Hi,

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• You have what looks like a dry necrotic ulcer affecting the lateral malleolus of your ankle (attachment removed to protect patient identity). I suspect this is likely to be due to venous insufficiency and given its distribution.

• This is where the valves, which normally encourage blood to flow the correct way from the superficial veins in the leg to the deep veins, have been damaged, causing backflow and venous stasis or sluggish flow in the leg veins.

• It is often associated with swelling of the legs and varicose veins or prominent, tortuous and tender veins with dark discoloration of the skin. Do you have any of these other symptoms?

• Symptoms are usually made worse by prolonged periods of standing still or sitting. Swelling and discomfort may improve with walking and leg elevation.

• Another possible cause is arterial insufficiency in which the blood supply to the leg is impaired due to narrowing of the arteries. This is often associated with diabetes, high blood pressure, smoking and other diseases such as heart disease, stroke or kidney problems or a family history.

• If the ulcer is not getting better with your current treatment methods, then you need a diagnosis to provide a cause. This is best achieved with a simple ultrasound duplex assessment of the veins in the leg to demonstrate if there is any abnormal blood flow direction.

• From the location of the ulcer it may be the short saphenous venous system is impaired.

• Treatment of ulcers due to venous insufficiency starts with three layer compression bandaging and elevation of the leg to prevent pooling of blood.

• It may be necessary to have an operation to either block the superficial veins or to remove them completely. You will need to see a vascular surgeon to have this investigated.

• Other possible causes that would need to be considered include chronic infection and so, a swab of any discharging area would need to be performed in order to try to identify any infectious organisms.

• Also, an abnormal growth such as a tumor or cancerous growth would need to be considered and so a biopsy (taking a small area of the ulcer edge to view under a microscope) would need to be considered.

• In summary, if things have not improved after three months, you need to see a vascular specialist and possibly a skin specialist or dermatologist to have the tests to know the underlying cause so that it can be treated effectively. I hope this helps.

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