is a leg ulcer?
A leg ulcer is a breakdown of an area of skin on
the leg which extends into the lower layers and may produce discharge.
causes a leg ulcer?
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.
are the different types of leg 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.
can be done to prevent leg ulcers?
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.
- Elevating the feet It is helpful to elevate
the feet on a footstool when sitting down, in order to relieve the pressure
on their veins. Provided a person does not have high blood pressure, problems
with their arteries or an underlying heart condition, the end of the bed can
be elevated slightly to increase blood flow back to the heart.
- Support stockings Older women with varicose
veins should be encouraged to wear support tights. Unisex knee and thigh length
support stockings are also available to buy.
- Exercise Flexing the feet regularly when
sitting, in order to enable the calf muscles to pump the blood out of the
veins. Walking can also be helpful for this purpose.
- Diet Maintaining a healthy diet and a
normal body weight helps to avoid excess pressure on the veins and arteries
caused by obesity.
Problems with the arteries
- Pains in the legs If the person has problems
with their arteries, it may appear as an intermittent pain in the legs which
develops when they walk and is relieved by rest, known as intermittent claudication.
Their feet may also appear cold and mottled.
- Cuts and scratches Because the blood
circulation is poor, the supply of nutrients and oxygen to the legs is limited
and the healing power of the skin is reduced. For this reason it is vital
that the even the smallest scratches or cuts to the leg are avoided if possible,
as an ulcer can develop quite quickly as a result. This can be done by moving
obstacles out of the persons way, particularly things that are low down
such as coffee tables or stools. Sharp corners on furniture should be avoided.
Small children and animals should not be allowed to climb up on the elderly
person as they can accidentally scratch their skin. Small cuts and scratches
which inevitably occur should be promptly treated.
- Smoking Smoking can cause a disorder
of the arteries known as atherosclerosis. This is a condition where the walls
of the arteries become lined with fatty deposits. This leads to hardened,
narrowed arteries resulting in a reduced blood flow around the body, especially
to the legs. Smoking can also reduce the amount of oxygen in the blood circulating
around the body and to the extremities, including the legs.
- Washing The skin should be washed with
warm water and a very mild soap, and dried very gently, especially between
the toes. It is important to inspect the skin regularly for signs of skin
- Dry skin If the skin is dry, an emollient
or lanolin can be massaged in. Toenails should be cut straight across and
more difficult procedures should be referred to a chiropodist.
- Keeping warm While an older person should
be kept warm with blankets, warm clothes and socks in cold weather, hot water
bottles should be avoided. If they are experiencing problems with their circulation,
the sensation in the feet is often not as good as before. For this reason,
direct heat may not be perceived to be as hot as it is and can cause damage
to the skin. The person should wear well-fitting shoes and socks to avoid
constricting the blood flow around the feet.
- Exercise Gentle to moderate passive or
active exercise should be encouraged if tolerated. This will promote the circulation.
is the best way to care for a leg ulcer?
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
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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