(Tuesday, 2nd Sep, 2014)
A leg ulcer is a breakdown of an area of skin on the leg which extends into the lower layers and may produce discharge.
Leg ulcers develop due to problems with the circulation in the legs, either the veins or arteries. Ulcers that occur due to problems with the veins are called venous ulcers, while ulcers caused by problems with the arteries are called arterial ulcers.
Veins are vessels that collect blood from around the body and return it to the heart. The high pressure of blood in the larger veins deep inside the leg can damage the valves that regulate the flow of blood through them. This causes great pressure on the smaller veins nearer the surface of the skin, causing varicose veins. Because of this increased pressure, the nutrients leak out of these veins into the tissue around them. This results in malnourished skin, which breaks down more easily.
Leg ulcers can also develop as a result of problems with the arteries, which are large blood vessels that supply blood from the heart to the organs around the body. An obstruction of the artery, due to a narrowing of its walls, for example, can mean that areas such as the legs do not receive enough oxygen and nutrients. This results in unhealthy skin, which is more likely to break down and lead to the formation of an ulcer.
Problems with the veins
If a person has varicose veins, ensure that they do not stand for prolonged periods. Activities such as crossing the legs can also disrupt the flow of blood and lead to problems and so should be avoided.
Problems with the arteries
Keep wound covered
One of the most important aspects of caring for a leg ulcer is keeping the wound clean and free from harmful germs. For this reason, open wounds should be kept covered with a sterile dressing at all times.
Your doctor can arrange to have the leg ulcer dressed regularly by the public health nurse or at the local hospitals dressing clinic, if there is one nearby. Wounds generally tend to heal better when kept moist, so it is important that the dressing stays intact until it is due to be changed and that it is not removed.
Look out for infection
Keep an eye out for any signs of infection, which may be indicated by an increase in the amount of ooze from the wound, which can be seen on the dressing. The area of skin around the wound can become very red, hot and painful. You may not be able to see this, but take note if if the leg becomes more painful than usual. The sufferer may also have a raised temperature and sometimes can become temporarily confused or agitated when infection sets in.
If poor circulation in the veins is a problem, the leg is often bandaged with layers of bandages to increase the flow of blood back up the leg into the heart. It is important that these bandages are kept on and do not fall off or loosen.
With such large dressings, washing can be a problem , as the outer bandages should be kept dry. It can help to cover the dressing and leg with a clean black refuse sack and keep it out of the water while bathing or showering. It can help to use a plastic chair in the shower for the person to sit on if it is a walkin unit and to hand-hold the shower head to direct the flow of water away from the dressing.
A high calorie, high protein, high vitamin diet is recommended to help the skin to repair itself. Vitamins B and C are particularly important for repair of the cells that make up the skin. Iron will help to improve the uptake of oxygen in the blood. It is a good idea to talk to your doctor or public health nurse about this, as the person with a leg ulcer might have other medical conditions that restrict what they are allowed to eat. In this case they may refer you to a dietitian for advice.
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