Leg Ulcers

What are leg ulcers?

Ulcers are wounds that are slow to heal or do not heal. They involve loss of skin and tissue on the legs or feet and often relate to vascular problems where the circulation is compromised. The most common cause of leg ulceration relates to venous disease where the veins do not work properly to take blood back up to the heart from the feet.  Ulcers can also be caused by blocked arteries (peripheral arterial disease). Patients with diabetes and nerve damage (neuropathy) are also particularly prone to developing ulcers.

Dressings and antibiotics are often not enough to heal ulcers. A thorough assessment of the circulation and treatment to address the underlying cause of the ulcer may assist with healing in patients with both venous and arterial problems. Patients with diabetic nerve damage (neuropathy) also require relief of pressure from the area. Dr Freeman has extensive experience with all these causes of leg and foot ulceration and can provide treatments to assist with ulcer healing.

What is venous insufficiency?

The most common cause of leg ulceration relates to venous disease.  This is when the veins do not function properly to take blood from the leg back up to the heart.  The pressure rises and fluid leaks out of the veins.  This can initially cause swelling.  This progresses to causing skin changes such as pigmentation and dermatitis.  Finally, the skin can break down causing a wound that does not heal.  Venous ulcers may be precipitated by an injury to the leg, including relatively minor trauma. They can be painful and can become infected.

What should I do if I have a venous ulcer?

A comprehensive assessment will be performed including a detailed history from the patient regarding their ulcer, this includes any medical problems you have and medications you are on.  Patients are assessed with ultrasound studies to examine the circulation and particularly the extent of venous disease involving the superficial and deep veins.  The pressures may need to be measured in the leg and compared to the arm.  These tests are best performed by a specialist vascular sonographer experienced in the assessment of patients with ulcers.

What is the treatment for venous ulceration?

Patients with venous ulcers need regular dressings.  If the ulcer is infected, patients will require antibiotic treatment.  In addition, following a specialist assessment some patients may be appropriate for formal multi-layer compression bandaging from the toes to the knee.  This needs to be applied by an experienced nurse and the bandages left intact until the nurse returns to change and reapply the bandaging.  The level of compression is determined by a Specialist and patients need to follow up with the specialist to ensure that the bandages are being appropriately applied.

How long will I need compression for?

Compression bandages are usually needed for several weeks.  Once the ulcers are healed patients will then be transitioned to wearing a compression stocking in order to prevent the ulcers from returning.  It is important that patients are individually measured up for these stockings. Stockings will need to be replaced when the elastic deteriorates as they become less effective in preventing the ulcers from returning.  Stockings need to be worn during the day but can be taken off at night.

Are there any alternatives to wearing long-term stockings?

Patients with ulcers related to venous disease are encouraged to be active.  Regular walking helps promote circulation and can assist with ulcer healing. Some patients may also be suitable for procedures aimed at repairing the diseased veins.  These treatments include laser of the refluxing veins or stenting (inserting a small scaffold into) blocked pelvic veins.  A proportion of patients might also benefit from open surgery.  Dr Freeman can determine which patients are suitable for these treatments and is experienced in performing them.

Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.