Leg ulcers are breaks in the skin (generally below the knee) that can take a long time to heal due to underlying disease. You may hear them described as ‘chronic wounds’.
The most common cause of chronic leg ulcers is poor blood circulation in the legs caused by a problem either in the veins, causing venous leg ulcers, or arteries causing arterial leg ulcers. Sometimes the cause is a combination of the two (mixed venous-arterial ulcers).
Approximately 70% of leg ulcers are venous. They are caused by increased blood pressure in the veins of the lower leg. As a result, fluid ‘oozes out’ of the veins beneath the skin making it swell and thicken. You are at risk of developing a venous ulcer if you have varicose veins, have had a deep vein thrombosis (DVT) in the past, or have a family history of venous disease.
Arterial ulcers tend to be found at the lower end of the leg, on the foot or toes. They generally cause pain at night, or if your legs are elevated. You are at risk of developing an arterial ulcer if you have heart disease, diabetes, peripheral vascular disease or if you smoke.
It is very important that your doctor examines your wound to determine the type as this will guide treatment. Diagnosis is usually made on the basis of the appearance and location of the ulcer (see table below).
Differences between venous leg ulcers and arterial leg ulcers
- Swollen foot and leg
- Ulcer is usually superficial/shallow with sloping edges
- Dry, itchy, red or brown skin around the ulcer. Eczema may be present
- Painful, especially if infected
- Cold feet and legs with a whitish or bluish, shiny appearance
- Round, ‘punched out’ and painful ulcer
- Increase in pain when your legs are elevated
- Decrease in pain when sitting
Consulting a healthcare provider
If you think you have a known vascular disease and a wound on your lower leg, then you should consult a health care provider right away. If you are unsure about a wound that persists on your lower leg, then you should also consult a provider. While you are caring for your wound at home per your provider’s instructions and the wound gets worse or persists or if there are signs of infection such as redness, swelling, fever, pain or burning, increased drainage, becomes warm to the touch, then consult a health care provider.
Products for leg ulcers
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Mepilex Border Flex (Oval)
Nurse and Patient Preferred Brand Mepilex® Border Flex (Oval) is an easy to use, all-in-one, hospital quality dressing featuring Safetac® technology.
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Other Wound Types
Abrasions (or gazes) are superficial wounds, where generally, only the outermost layer of the skin (the epidermis) is rubbed away. Sometimes abrasions go deeper into the skin layers (dermis).
Many burns affect only the skin, and are superficial (like a sunburn). Burns that affect deeper tissue are classed as partial-thickness (wet, painful, pink or red) or full-thickness (dry, no pain, grey/brownish, may look like normal skin but without sensation) depending on the depth. All burns may be painful, and it is often the superficial and partial-thickness ones that are the most painful.
About 15% of people with diabetes will develop a foot ulcer due to aspects of the disease. Diabetes can damage nerves (neuropathy) and is often associated with poor blood circulation in the lower legs. These may make a person with diabetes more susceptible to wounds, infection and delayed wound healing.
A skin tear usually occurs in the elderly or those with fragile skin, as a result of a bumping into something, dressing changes with inappropriate dressings, or vigorous washing and drying of the skin.
A pressure injury, often known as a pressure ulcer, pressure sore or bed sore, is an injury to the skin and underlying tissue caused when too much pressure is placed on the affected area.
Some patients who have radiotherapy or radiation treatments may experience skin reddening and breakdown in the area. These are called radiotherapy or radiation skin reactions.
Scars are a natural part of the skin’s healing process, following a wound or injury. Scars are formed when the dermis – the deep, thick layer of skin – is damaged.
Surgical Wounds or Incisions result when you have an operation, or if you get a cut accidentally. The incision, wound or cut is closed using stitches (sutures), clips glue or tape, depending on the site and depth of the cut.
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