Leg ulcers

Point prevalence of 0.3-0.6% and a lifetime risk of 1.0-1.8%.

Affects up to 1% of adults in developing countries.

Chronic leg ulcers commonly develop in patients with diabetes or vascular insufficiency.

Venous leg ulcers are associated with significant morbidity, and impaired quality-of-life, and significant health care costs.

Venous ulcers represent approximately 70% of all causes of leg ulceration and are considered the most advanced stage of chronic venous insufficiency.

Decreased tissue blood flow is the major contributor to ulcer formation and delayed healing.

All venous leg ulcers are colonized by bacteria and some develop overt infection.

Suspected that abnormal tissue perfusion with microthrombi, up regulated integrin expression that promotes platelet and granulocyte aggregation, increased venous pressure, autonomic nervous system increased vasoconstriction contribute to ulcerations.

50-60% of venous ulcers are the result of postthrombotic vein damage and the remainder develop in postthrombotic conditions, i.e., primary valvular insufficiency.

Due to arterial insufficiency typically occur on toes, heels and anterior shin and the malleoli.

Venous ulcerations typically occur above the lateral or medial malleoli and have a history of chronic venous insufficiency, stasis dermatitis and history of deep venous thrombosis.

With venous ulcers significant maceration and drainage are usually present at the malleoli or calf.

Underlying conditions that cause chronic venous ulcers associated with leg edema include: venous insufficiency, heart failure, cirrhosis, chronic kidney disease, and deep vein thrombosis.

Calcium channel blockers, NSAIDs, and certain oral hypoglycemics can cause leg edema and lead to chronic venous ulcers.

The primary prevention and treatment of venous ulcers is to control edema, and this can be accomplished by mechanical compression which can improve healing outcomes and shorten time to healing.

Among strategies to reduce edema: mechanical compression, wraps/bandages, stockings, and boots there’s insufficient evidence to definitively recommend a gold standard strategy.

May complicate sickle cell disease and other hemolytic anemias, contributing to debility poor quality of life and early mortality.

Incidence of leg ulcers in sickle cell disease varies from 8-75% depending upon the geographic location of the patient, genotype of hemoglobin abnormality, age, contribution of trauma to the ulceration, hemoglobin concentration, and accompanying hypercoagulable state, or the presence of a lupus anticoagulant.

Treatment options include antibiotics, Unna boots, compression dressings, silver and zinc oxide gauze, skin grafts bacterial suppression of bacterial infection, and reduction of venous stasis.

Using systemic antibiotics does not improve venous leg ulcer healing.

Cadexomer iodine topical antibiotic maybe associated with better healing compared with usual care of venous leg ulcers.

Chronic osteomyelitis is a complication of chronic leg ulcers, and it requires prolonged intravenous broad-spectrum antibiotic treatment and frequent surgical intervention.

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