Aging Begins at 30

Getting Rid of Leg Ulcer Is Difficult and Lengthy

Remember Juanita had diabetes and a leg ulcer. She needed treatment.

Treatment has two aspects. First, the control of body-wide disease, e.g. high blood pressure, diabetes, or heart failure and second, the local management of the ulcer. Systemic disease can be treated medically, for example with beta blockers or surgically by tying off non-working incompetent veins or with vascular reconstruction or minor amputation in arterial ulcers . If very contaminated, local antibiotics can be used and rarely oral or injectable antibiotics. In venous ulcers, the swelling or edema should be reduced by bed rest, diuretics, pressure, or exercise. There may be need to clean the ulcer bed with occlusive or moist dressings (but don't make them soggy), with dissolving enzymes such as elase, or by surgical trimming (debridement). More permanent dressings may be oxygen permeable such as op site or oxygen impermeable such as hydrocolloid or duoderm and these can often be left for 7 days. Other dressings, derisan absorb fluid exudates and tidy up the ulcer. Bland applications such as aquaphilic ointment are good but bag balm (cow mastitis ointment) and other worse applications should not be used. In fact, it is important to do a patch skin test of the patients home remedies to make sure they haven't become allergic to them. If the ulcer has been there more than a year, a biopsy should be examined microscopically to rule out serious disease or complications.

An old fashioned remedy called Unna's boot consists of gauze soaked in glycerin, gelatin, and zinc until it is stiff is still used and is left on for a week and then changed weekly for up to 6 weeks when miraculous healing can be found. It will take two to three months to heal (whatever method is used) and some of the stubborn ulcers will need skin grafting.

Knowing which kind of ulcer it is, leads to the correct treatment and healing. Avoid corn removers, all foot preparations, injury, tobacco, and alcohol use. Protective foot wear or support stockings is important.

Patients need education on foot care and close monitoring of their skin and any underlying disease. An exercise program is often beneficial.

Juanita had a small artery disease ulcer secondary to diabetes and needed an arterial bypass graft and avoided the severe limitation that an amputation would have caused.

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See related Patient Topics Bones, Joints and Muscles, Injuries and Wounds or Leg Injuries and Disorders.

See related Provider Topics Bones, Joints and Muscles or Injuries and Wounds.

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