Leg Ulcer Clinic

There are several types of leg wounds (ulcers) that we see in a vascular practice. Broadly there are two types, venous or arterial however variations include mixed (arterial and venous), diabetic and hypertensive. Most ulcers result from a simple scratch and may be present from a few weeks to many months. Some ulcers may heal over time however if the underlying cause is not corrected, ulceration often recurs.

• Venous: Venous ulcers are most common and usually develop along the inside of the lower leg between the knee and the ankle. They result from continuous high pressure within the veins because blood is either flowing the wrong way (varicose veins) or obstructed by blood clots. The ulcer itself often begins as a minor scratch that over time may develop into a large irregular wound. They tend to ooze fluid and may be painless; however, pain varies unpredictably and often is relieved with leg elevation.
  
  
• Arterial: Arterial ulcers form as a result of poor arterial blood supply due to a blockage in the arterial tree somewhere between the heart and the site of the ulcer as a result of peripheral vascular disease, diabetes mellitus or trauma. Arterial ulcers tend to be small, dry and very painful often relieved by putting the leg in a dependant position and aggravated by elevation. They commonly develop over bony areas such as the outside of the ankle and diabetics often present with ulcers under the toes or on the ball of the foot. Because the peripheral nerves in diabetics degenerate over time they have poor sensation and may be unaware of trauma or the rubbing of footwear. Diabetic ulcers are often painless.

Our well-equipped specialist vascular practice provides comprehensive management of patients presenting with vascular ulceration. Our team includes vascular surgeons, nurses and vascular sonographers who collaborate to determine the cause of the ulcer and develop a treatment plan. Your doctor will evaluate your condition based on your medical history and a physical examination of the ulcer. A dressing regime will be instituted and commonly a vascular ultrasound to determine the underlying pathology is arranged. If arterial disease is suspected the first line of investigation is to calculate Ankle-Brachial Pressure Index which determines overall flow to the foot. This may be combined with an ultrasound to look at the main arteries to determine if there is an obstruction. If your ulcer is thought to be venous in origin, an ultrasound of the deep and superficial veins will be required to assess blood flow out of the leg. All of these procedures are painless.

The goals of treatment for leg ulcers are to reduce discomfort and ensure faster healing of the wound. Early detection and treatment of the leg ulcers can avoid infections and prevent the wound from becoming worse especially if you have diabetes. The general treatment options depend on the type of ulcer that you have however your doctor may individualise your treatment plan based on your health.

• If the ulcer is venous in nature, the aim of treatment is to prevent blood from pooling in the leg. Initially this is achieved with graduated compression stockings however significant underlying problems often require correction, i.e. treating varicose veins by either endovenous laser, ultrasound guided sclerotherapy or surgery. If the problem is caused by obstruction to blood flow from a blood clot, blood-thinning medication and long-term compression will be required.
  
  
• To heal arterial ulcers, blood flow to the foot must be increased. This is done by using balloons and/or stents to reopen narrowed arteries however some patients require more significant bypass surgery.

Your doctor will also advise you on how to take care of your leg ulcer at home. Follow your doctor's guidelines which include:

• Wound care involving regular debridement and dressings are essential; keep the wound clean and dry. You will need to visit the ulcer clinic regularly to monitor you progress and review your dressing regime. Dressing should be changed as instructed
• Wear compression if suggested
• Take any medications prescribed - antibiotics are rarely required
• Drink lots of fluids and eat a healthy diet including fruits and vegetables
• Wear shoes that fit your leg well - special orthotic devices or shoes may be required
• Exercise regularly