Leg ulcers are an important issue. It is a relatively common and annoying condition that worsens patient’s life quality and may cause chronic impairment.
Leg ulcers are formed on the basis of arterial and venous disorders, or their combinations.
Arterial causes: Ulcers of the lower extremities may occur as symptoms of advanced stages of chronic lower limb ischemia. This disease is caused by atherosclerosis leading to narrowing of lower limb arteries and thereby worsening oxygen supply to tissues. In addition to claudication (limb pain during walking) advanced forms of chronic lower limb ischemia may manifest by leg ulcers occurrence. Ulcers tend to emerge in ischemic terrain suffering from lack of nutrients and oxygen.
Note: I will devote the rest of this article only to venous leg ulcers, because they are the most common type of leg ulcers. If you are interested in issue of chronic lower limb ischemia, I refer you to relevant article dedicated to this problematic.
Venous causes: Venous leg ulcers belong to a group of conditions known as chronic venous diseases of lower extremities. These ulcers are caused impaired function of veins draining blood from flower extremities – a condition known as chronic venous insufficiency (CVI). The blood starts to accumulate in veins, which is followed by local increase of venous blood pressure. This leads to irritation of local tissues. Affected lower limb begins to swell and subcutaneous tissue stores dark pigment. In advanced stages of the disease there emerge the ulcers.
The chronic venous insufficiency can be worsened by other risk factors such as recurrent skin infections (typically erysipelas), diabetes, deep vein thrombosis, superficial vein phlebitis and lack of physical exercise. When some of these factors combine, the risk of ulcers significantly grows.
Leg ulcers are differently deep skin defects that can fester and often smell unpleasantly. The process of classical venous ulcer formation is usually chronic. In the beginning there are visible varicose veins varicose veins, later both dark pigmentation and swelling around the ankles occur. Skin quality deteriorates, becomes thinner and looses hairs. Any minor injury can cause a shallow defect formation that starts to deepen and enlarge. Bacterial infection of such defects is usually inevitable; the infected ulcer oozes and suppurates. Some leg ulcersare pretty painful.
Venous ulcers are clearly visible. A part of the examination process should be an ultrasound of venous system of lower extremities that indicates venous continuity and function.