What is the Best Way to Heal a Leg Ulcers? Explained by Dr. Sumit Kapadia
Leg ulcers are a persistent and painful condition that can significantly affect a person’s quality of life. As a vascular surgeon, I often see patients who have struggled with leg ulcers for months, even years.
Leg ulcers are more than just a skin issue; they’re often a sign of underlying vascular problems that need attention. In India, where chronic venous disease is prevalent, leg ulcers are a common health concern, particularly among the elderly and people with venous insufficiency.
In this blog, I’ll explain what leg ulcers are, their causes, and the most effective treatments available today, sharing insights and success stories from my practice.
What Is a Leg Ulcer?
A leg ulcer is an open sore that develops when the skin breaks down and exposes the underlying tissue. These ulcers can be shallow or deep and are often slow to heal, sometimes persisting for weeks or even months.
The most common type of leg ulcer is the venous leg ulcer, which accounts for over 80% of all leg ulcer cases. Venous ulcers typically occur on the lower leg, near the ankle, and are often accompanied by swelling, discoloration, and aching.
Leg ulcers can severely impact mobility and daily life, causing discomfort and sometimes infection. Therefore, early diagnosis and prompt treatment are crucial in preventing complications and promoting healing.
What Causes a Leg Ulcer?
The causes of leg ulcers vary, but the majority are linked to poor circulation. The underlying cause often falls into one of three categories: venous, arterial, or neurotrophic.
Venous Leg Ulcers
These are the most common type, caused by chronic venous insufficiency. When veins in the legs fail to return blood efficiently to the heart, blood pools in the lower extremities, increasing pressure in the veins. This pressure leads to skin breakdown, resulting in ulcers. Risk factors include varicose veins, deep vein thrombosis (DVT), obesity, and prolonged standing or sitting.
Arterial Leg Ulcers
These ulcers occur due to poor arterial circulation, often as a result of atherosclerosis (plaque buildup in the arteries). They tend to develop on the feet or toes and can be quite painful. Patients with peripheral artery disease (PAD), diabetes, or high cholesterol are at a higher risk for these ulcers.
Neurotrophic (Diabetic) Ulcers
Neurotrophic ulcers are commonly seen in people with diabetes. Due to nerve damage (neuropathy), diabetic patients may not feel injuries to their feet, which can lead to open sores that go unnoticed and become infected.
In India, it is estimated that over 1 million people suffer from chronic leg ulcers each year, with venous leg ulcers being the most prevalent. Early identification of the type of ulcer is key to effective treatment.
Best Treatment for Venous Leg Ulcers
When treating venous leg ulcers, the primary focus is improving circulation in the legs. As a vascular surgeon, my approach is typically two-fold: treating the wound and addressing the underlying venous insufficiency.
Compression Therapy
Compression therapy is the gold standard for venous leg ulcers. By applying pressure to the legs using compression stockings or bandages, we can improve blood flow and reduce swelling. The compression methods may range from simple crepe bandages to more effective 2 layered or even 4 layered dressings, which can be changed at weekly intervals. Studies have shown that compression therapy increases the rate of ulcer healing by up to 70%. In most cases, patients need to wear compression garments for several months after the ulcer heals to prevent recurrence.
Wound Care
Proper wound care is essential for healing leg ulcers. This involves cleaning the ulcer, removing dead tissue (debridement), and applying appropriate dressings. We often use modern advanced wound dressings that are designed to maintain a moist environment, promote healing, and prevent infection. Infected ulcers may require antibiotics, but it’s essential to manage the wound regularly to ensure it heals properly.
Endovenous Ablation
For patients with severe venous insufficiency, we may recommend endovenous ablation, a minimally invasive procedure that closes off faulty veins. This procedure improves circulation by rerouting blood to healthier veins. Endovenous ablation has proven effective in reducing ulcer recurrence rates and promoting faster healing.
Sclerotherapy
In cases where venous leg ulcers are related to varicose veins, sclerotherapy can be a useful treatment. This involves injecting a solution into the affected veins, causing them to collapse and eventually fade away. It’s an outpatient procedure with minimal downtime, making it a convenient option for many patients.
Negative Pressure Wound Therapy (NPWT) or Vacuum Assisted Closure (VAC)
In these advanced methods, a special medical grade foam is used to cover the wound and then is sealed by impervious plastic drapes and then further connected via sensors and tube to a low pressure suction or vacuum machine. This helps in draining the edema fluid or discharge and also imrproves granulation tissue within the wound and can help in accelerating the wound healing.
Best Way to Heal Leg Ulcers
The best way to heal leg ulcers depends on a combination of early diagnosis, appropriate treatment, and lifestyle modifications. Here’s a comprehensive approach to ensure optimal healing:
Improve Circulation
For venous leg ulcers, wearing compression stockings regularly is crucial. By improving blood flow in the legs, compression helps reduce swelling, promotes healing, and prevents the recurrence of ulcers.
Keep the Wound Clean and Moist
Proper wound care involves cleaning the ulcer and applying dressings that keep the wound moist, which accelerates healing. Avoid using harsh chemicals like hydrogen peroxide, as they can damage healthy tissue. Instead, follow the guidance of your healthcare provider on appropriate wound care techniques.
Elevate Your Legs
Elevating the legs above the heart level several times a day can help reduce swelling and improve blood flow. I often advise patients to elevate their legs for 30 minutes at a time, 3 to 4 times a day, particularly if they have venous insufficiency.
Stay Active
Regular physical activity, such as walking, can improve circulation in the legs and reduce the risk of ulcers. Exercises that focus on calf muscle strengthening are particularly beneficial as they help pump blood back toward the heart.
Manage Underlying Health Conditions
Control conditions like diabetes, high blood pressure, and obesity, can exacerbate leg ulcers. In my practice, I’ve seen many patients with uncontrolled diabetes develop ulcers that become chronic and difficult to heal. Proper blood sugar management can dramatically reduce the risk of ulcers and improve healing outcomes.
Minimally Invasive Surgery
In cases where venous insufficiency is severe or ulcers are recurrent, endovenous laser treatment (EVLT) or other surgical interventions can help restore normal blood flow. These procedures are highly effective and minimally invasive, offering a long-term solution to chronic leg ulcers.
Conclusion
Healing a leg ulcer requires a comprehensive and patient-centered approach. Early diagnosis, proper wound care, and addressing underlying circulation problems are essential for promoting healing and preventing recurrence.
As a vascular surgeon, I’ve seen first-hand the positive outcomes that result from timely treatment and lifestyle modifications. For anyone suffering from a leg ulcer, don’t delay seeking medical care. With the right treatment, even chronic ulcers can heal, restoring not only the skin but also the patient’s quality of life.
FAQs
Leg ulcers are often caused by poor circulation, especially in people with chronic venous insufficiency. Other causes include arterial disease, diabetes, and nerve damage.
Leg ulcers are treated through a combination of compression therapy, proper wound care, and, in some cases, surgical interventions like endovenous ablation or sclerotherapy.
Common symptoms include open sores on the leg, swelling, aching, skin discoloration, and sometimes infection.
Yes, leg ulcers can be prevented by managing underlying health conditions, wearing compression stockings, staying active, and elevating the legs regularly.
There are three primary types of leg ulcers: venous, arterial, and neurotrophic (diabetic). Each type is caused by different underlying factors, such as poor venous or arterial circulation or nerve damage.
MBBS, MS, MRCS, DNB-Fellow
Dr. Sumit Kapadia
Dr. Sumit Kapadia / MR KAPADIA SUMIT a gold-medalist from Baroda Medical College, obtained his general surgical training and senior residency from SSG Hospital, Vadodara.
MBBS, MS, MRCS, DNB-Fellow
Dr. Sumit Kapadia
Dr. Sumit Kapadia / MR KAPADIA SUMIT a gold-medalist from Baroda Medical College, obtained his general surgical training and senior residency from SSG Hospital, Vadodara.
