leg ulcers

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Q: leg ulcers?
I have a friend who suffers painful ulcers for the past 13 months, has been at numerous drs, who only dress his legs and tell him to take painkillers.
Anybody there that has the same problem and a resolution?
Live in Ireland.

Thanks.

A: Depending on your friends age and state of health,it might be possible to operate.
If not a very good success rate is achieved by using compression bandaging.
Can your friend ask to be referred to a leg ulcer specialist and clinic?
He is entitled to ask for a second opinion.

Q: hOW DO I PREVENT LEG ULCERS FOR DIABETICS?
I get leg ulcers they appear as bubbles on my legs. When they break open fluid (mostly water) comes out, then it gets painful and bigger and as always it gets infected. So, why do doctors treat it like a burn when I did not burn myself? I always wear compression socks and have my feet raised. And what causes Cellulitis and why do I always get it and how do I prevent it from happening again.

A: Cellulitis is simply the term for inflammation to the cellular tissue under your skin. Most anytime one has a wound the area around it becomes red and inflammed. That’s cellulitis.

Ulcers in the lower legs are very common in diabetics, and very troublesome. The circulation to your extremities is compromised by your disease and that causes the blisters, sores and ulcers. The most important thing you can do is increase circulation to the area. Something we used to do is massage lotion into the feet and legs once a day … twice is better. This isn’t just rubbing lotion on. It needs to be massaged into the skin until it’s totally absorbed. The massage is what causes increased circulation to your feet and legs, the lotion just makes is easier to do without pulling on the skin so much.

When you wash your feet, in your bath or shower, pay close attention to them. Dry thoroughly, between the toes, around the nail cuticles, etc. Your doctor probably has some literature about diabetic foot care. If not you can look it up on the internet.

Best of luck to you!

Q: Any advice welcome re treating leg ulcers with manuka honey?
Been reading extensively about the healing properties of manuka honey for leg ulcers and wondered if anyone had tried it and what the results were. It is not cheap £17 for a small jar in our local health food shop and I would welcome comments before I shell out for it.

Do you just apply direct to the ulcer and cover?

A: Manuka Honey is excellent for the treatment of leg ulcers because it has the ability to repair damaged skin and regenerate new skin growth. Manuka Honey also has natural antibacterial properties that can eliminate any harmful bacteria that could cause infection. It creates a moist healing environment that allows the would to naturally lift the scab, allowing the new skin growth to re-grow flush with the surface of the skin, rather than below the scab which causes deformity or scarring.

It is recommended that you apply the Manuka Honey to a bandage and then place the bandage directly over the affected area. This should be done 1-2 times per day. Manuka Honey heals wounds and skin ulcers very quickly.

Q: i am looking for a specialist who knows anything about gravatational leg ulcers and how to treat them?
i have 2 gravtational ulcers on my left ankle. i have a history of dvt’s in both legs and have seen many dr’s regarding this problem. i am looking for help in regards to a specialist who can treat and or heal these for me. i have extreme amount of pain with these ulcers and have no quality of life what so ever.i am 36. and male.

A: Leg ulcers
What are leg ulcers?
Leg ulcers skin loss on the leg or foot due to any cause. They occur in association with a range of disease processes, most commonly with blood circulation diseases. Leg ulcers may be acute or chronic. Acute ulcers are sometimes defined as those that follow the normal phases of healing; they are expected to show signs of healing in less than 4 weeks and include traumatic and postoperative wounds. Chronic ulcers are those that persist for longer than 4 weeks and are often of complex poorly understood origin.

Ulcers may be provoked by injury or pressure such as from a plaster cast or ill-fitting ski boot. They may also be caused by bacterial infection, especially impetigo, ecthyma and cellulitis and less often tuberculosis or leprosy.

Chronic leg ulceration affects about 1% of the middle-aged and elderly population. It most commonly occurs after a minor injury in association with:

Chronic venous insufficiency (45-80%)
Chronic arterial insufficiency (5-20%)
Diabetes (15-25%)
Chronic leg ulcers may also be due to skin cancer, which may be diagnosed by a skin biopsy of the edge of a suspicious lesion. There are also many less common causes of ulcers including systemic diseases such as systemic sclerosis, vasculitis and various skin conditions especially pyoderma gangrenosum.

What causes leg ulcers?
Venous insufficiency refers to improper functioning of the one-way valves in the veins. Veins drain blood from the feet and lower legs uphill to the heart. Two mechanisms assist this uphill flow, the calf muscle pump which pushes blood towards the heart during exercise, and the one-way valves which prevent the flow of blood back downhill. Faulty valves and impaired calf pumping action result in pooling of blood around the lower part of the leg to just below the ankle. The increased venous pressure causes fibrin deposits around the capillaries, which then act as a barrier to the flow of oxygen and nutrients to muscle and skin tissue. The death of tissue cells leads to the ulceration.

Arterial insufficiency refers to poor blood circulation to the lower leg and foot and is most often due to atherosclerosis. In atherosclerosis the arteries become narrowed from deposits of fatty substances in the arterial vessel walls, often due to high levels of circulating cholesterol and aggravated by smoking and high blood pressure (hypertension). The arteries fail to deliver oxygen and nutrients to the leg and foot resulting in tissue breakdown.

Diabetic ulcers are caused by the combination of arterial blockage and nerve damage. Although diabetic ulcers may occur on other parts of the body they are more common on the foot. The nerve damage or sensory neuropathy reduces awareness of pressure, heat or injury. Rubbing and pressure on the foot goes unnoticed and causes damage to the skin and subsequent ‘neuropathic’ ulceration.

Who is at risk of leg ulcers?
Certain conditions have been linked with the development of venous and arterial leg ulcers.

Venous ulcers Arterial ulcers
Varicose veins
History of leg swelling
History of blood clots, e.g. deep vein thrombosis (DVT)
Sitting or standing for long periods
High blood pressure
Multiple pregnancies
Previous surgery
Fractures or injuries
Obesity
Increasing age and immobility
Diabetes
Smoking
High blood fat/cholesterol
High blood pressure
Renal failure
Obesity
Rheumatoid arthritis
Clotting and circulation disorders
History of heart disease, cerebrovascular disease or peripheral vascular disease

Diabetic ulcers are more likely if diabetes is not well controlled by diet and/or medication. Ulcers are also more likely if there is poor care of the feet, badly fitting shoes and continued smoking.

What are the signs and symptoms of leg ulcers?
The features of venous and arterial ulcers differ somewhat.

Characteristics of venous ulcers:

Located below the knee, most often on the inner part of the ankles.
Relatively painless unless infected.
Associated with aching, swollen lower legs that feel more comfortable when elevated.
Surrounded by mottled brown or black staining and/or dry, itchy and reddened skin (gravitational or venous eczema).

Venous ulcers

Characteristics of arterial ulcers:

Usually found on the feet, heels or toes.
Frequently painful, particularly at night in bed or when the legs are at rest and elevated. This pain is relieved when the legs are lowered with feet on the floor as gravity causes more blood to flow into the legs.
The borders of the ulcer appear as though they have been ‘punched out’.
Associated with cold white or bluish, shiny feet.
There may be cramp-like pains in the legs when walking, known as intermittent claudication, as the leg muscles do not receive enough oxygenated blood to function properly. Rest will relieve this pain.

Diabetic ulcer
Neuropathic ulcer
(Spina bifida)
Traumatic ulcers (paraplegic)

Diabetic ulcers have similar characteristics to arterial ulcers but are more notably located over pressure points such as heels, tips of toes, between toes or anywhere the bones may protrude and rub against bedsheets, socks or shoes. In response to pressure, the skin increases in thickness (callus) but with a minor injury breaks down and ulcerates.

Infected ulcers characteristically have yellow surface crust or green/yellow pus and they may smell unpleasant. There may be surrounding tender redness, warmth and swelling (cellulitis).

What is the treatment for leg ulcers?
Where possible, treatment aims to reverse the factors that have caused the ulcer. As ulcers are often the result of both arterial and venous disease, careful assessment is needed first.

Venous leg ulcers, in the absence of arterial disease, are usually treated with exercise, elevation at rest, and compression. Compression must not be used if there is significant arterial disease, as it will aggravate an inadequate blood supply. Varicose vein treatment may also help.

A vascular surgeon should assess patients with arterial leg ulcers as they may require surgery to relieve the narrowing of the arteries.

It is also very important to treat underlying diseases such as diabetes and to stop smoking.

Cleaning the wound
No matter what the cause of the ulcer, meticulous skin care, and cleansing of the wound are essential. The removal of surface contamination and dead tissue is known as debridement. Surgical debridement or medical debridement using wet and dry dressings and ointments may be used. Maggots and larval therapy are occasionally recommended. Debridement converts the chronic wound into an acute wound so that it can progress through the normal stages of healing.

Treating infection
Antibiotics are not necessary unless there is tissue infection. This is likely if the ulcer becomes more painful and/or the surrounding skin becomes red, hot or swollen (cellulitis). Cellulitis may also result in fever and sickness. It should be treated with oral antibiotics such as flucloxacillin – the choice will depend on the causative organism. Topical antibiotics are best avoided because their use may result in increased antibiotic resistance and allergy.

Wound dressings
There is a whole range of specialised dressings available to assist with the various stages of wound healing. These are classified as non-absorbent, absorbent, debriding, self-adhering and other. Consult an expert in wound healing to determine the most suitable; this will depend on the site and type of ulcer, personal preference and cost.

Dressings are usually occlusive as ulcers heal better in a moist environment. If the ulcer is clean and dry, occlusive dressings are usually changed weekly; more frequent changes are avoided as dressing changes remove healthy cells as well as debris. Contaminated or weeping wounds may require more frequent dressing changes, sometimes every few hours. Honey dressings can be helpful.

Accelerate wound healing
Wound healing requires adequate protein, iron, vitamin C and zinc. Supplements may be prescribed if they are deficient in the diet.

New products to aid wound healing are available but require further research to determine their effectiveness. These include:

Growth factors and cytokines
Hyperbaric oxygen to increase tissue oxygen tension
Skin graft substitutes
Connective tissue matrix
Expanded epidermis
Epidermal stem cells
V.A.C. (vacuum assisted closure) device
In some patients, the ulcers fail to heal by themselves and require plastic surgery. The procedure typically involves taking skin from elsewhere on the patient’s body and placing it over the ulcer (skin grafting). Despite this procedure, it is not uncommon for the ulcer to recur.

Compression therapy
Compression therapy is an important part of the management of venous leg ulcers and chronic swelling of the lower leg. Compression therapy is achieved by using a stocking or bandage that is wrapped from the toes or foot to the area below the knee. This externally created pressure on the leg helps to heal the ulcer by increasing the calf muscle pump action and reduce swelling in the leg.

Several options are available to achieve compression:

Several layers of bandage (3 or 4-layer bandage compression system)
Shaped tubular bandage
Elastic graduated compression hosiery (stockings)
Unna boot (gauze bandage impregnated with zinc oxide)
Can leg ulcers be prevented?
To prevent leg ulcers and to promote healing of ulcers:

Be very careful not to injure your legs, particularly when pushing a supermarket trolley. Consider protective shin splints.
Walk and exercise for at least an hour a day to keep the calf muscle pump working properly.
Lose weight if you are overweight.
Stop smoking.
Check your feet and legs regularly. Look for cracks, sores or changes in colour. Moisturise after bathing.
Wear comfortable well-fitting shoes and socks. Avoid socks with a tight garter or cuff. Check the inside of shoes for small stones or rough patches before you put them on.
If you have to stand for more than a few minutes, try to vary your stance as much as possible.
When sitting, wriggle your toes, move your feet up and down and take frequent walks.
Avoid sitting with your legs crossed. Put your feet up on a padded stool to reduce swelling.
Avoid extremes of temperature such as hot baths or sitting close to a heater. Keep cold feet warm with socks and slippers.
Consult a chiropodist or podiatrist to remove callus or hard skin.
Wear support stockings (compression hosiery) if your doctor has advised these.

Q: Does anyone know what is the best way to treat leg ulcers?
I am a polio survivor and have bad healing power in my left leg, Ive tried rest and diet. but nothing seems to work. My doctor says it is getting worse. Any advice would be really appreciated.

A: If the Dr. states it’s getting worse, there is a possibilty of infection.
Has your Dr. prescribed an antibiotic?
If the wound is “healthy” and you have granulation tissue in the ulcer, it will look bright red and beefy, with exudate, small or large, try a product by Johnson & Johnson called Fibracol. It’s 90% collagen and 10% calcium alginate. Put that directly on your skin. It comes in a sheet form. Cover with gauze pads and wrap with roll gauze. Secure with tape.
If there is secondary strike through in the gauze wraps. Change everything as needed.
Contact your Dr. with insurance info and have clinic contact a DME-durable medical equipment-and have them supply you, they can also bill your ins. co.

Good luck!

Q: What is the difference between venous and arterial leg ulcers?
I know that arterial is arteries and venous is veins, what will you see?

A: Hi,

Arterial and Venous refers to the origin of the ulcer.

Venous ulcers originate due to the veins (in the leg) becoming stretched, with leaky walls and valves. This leads to excess fluid in the tissues which slows down oxygen and nutrient transfer, making it difficult for the skin to perform it’s vital functions (such as repairing skin damage).

Arterial ulcers (long-term breakdown in the surface of the skin) are caused, basically, not by the veins failing to remove excess fluid, but by the arteries failing to supply enough oxygen and nutrients to keep the tissues alive.
Arterial woulds are generally more difficult to treat and often more painful, particularly when lying down (eg in bed at night)

What they look like:
Venous leg ulcers tend to occur in the gaiter area of the lower legs – this is the bit of your leg from the ankle to the top of mid-length socks. They tend to be very shallow, like the surface skin is missing. You may also see the skin stained dark red or tan in this area and may have swollen ankles.

Arterial ulcers tend to be deeper and may appear lower on the leg and on the foot. They may smell more, and may be quite pale rather than healthy pink.

The treatment is very different: Venous ulcers are often treated with firm support bandaging, called compression. Compression may make arterial ulcers worse and cause additional damage.
Both form of disease may be present at the same time, making treatment more complicated

If you are diabetic, get professional advice immediately.

Q: Anyone used Septiclense on leg ulcers?
I have a problem clearing up a leg ulcer that does not respond to conventional medical treatment.I have been advised to use a product called Septiclense,normally used for the treatment of wounds etc. on animals,to treat my ulcer.
Does anyone know of the the use of this product for human use?

A: Website states following:-Developed to control and inhibit immediately any existing or possible challenge from airborne or contact germs resulting from minor external wounds, grazes or skin punctures that need on the spot attention.
I don’t think this is going to work for you.Yours is not a minor wound.
Buy a small pot of Manuka honey from your local health food shop and spread some on a clean dressing and apply to ulcer.
Bandage firmly and leave untouched for a few days as long as its not discharging..
The secret with leg ulcers is not to keep disturbing the dressing and bandage firmly from toes to knees–You can get a tubular bandage from chemist-Tubigrip to cover that area and apply on top of your dressing.
It is also important that you put your leg up on a stool when sitting so that the ulcer is rested and try not to stand in one position for too long.
Walking is good for your leg circulation.

Q: Why do people with Sickle Cell Anaemia suffer from leg ulcers?
and why are they also found in other haemolytic anaemia’s?

A: Sickle cell anemia is caused by an abnormal type of hemoglobin called hemoglobin S. Hemoglobin is a protein inside red blood cells that carries oxygen. Hemoglobin S, however, distorts the red blood cells’ shape. The fragile, sickle-shaped cells deliver less oxygen to the body’s tissues, and can break into pieces that disrupt blood flow.
Hemolytic crisis occurs when damaged red blood cells break down. Hence sickle cell anemia patients suffer from hemolytic anemia.
Leg ulcers
This usually occurs on the lower part of the leg. They happen more often in males than in females and usually appear from 10 through 50 years of age. The cause of leg ulcers is unclear.

Q: there is an ointment called ‘placengell’ made in Switzerland for the treatment of leg ulcers can you find it?
It was available some years ago from a firm in switzerland but they changed their address and now we cannot find them can you help?

A: I did a google search for placengel but all I could find were the links below. I hope you find them of some use.

Q: Has anyone ever tried Terrasil (all natural silver+oxygen skin cream) for leg ulcers?
My mother in law has leg ulcers and is thinking of trying this cream.I was wondering if anyone had tried it and what they thought.It costs quite a bit of money and i dont want her wasting it if its all a con.She is desperate to try anything to get rid of them. thanks

A: Suggest to her that she asks her GP about using Flamazine cream instead-you can look it up on Google(.Silver Sulphadiazine 1%)
If the doctor agrees he can give her a prescription for it.

Q: Any information about leg ulcers- how to reduce pain and general healing?

A: Hi, have you heard of Manuka honey? It is known to treat skin conditions where other conventional products fail. Manuka honey also has no side effects.

I have read a story of a man with a leg infection that could not be treated anymore. Until they started treating the wound with Manuka honey. He was cured within a week.

Q: anyone know the answer to leg ulcers?
does amyone know how to heal a leg ulcer real quick.they are very painful .

A: This is not a “real quick” kind of a deal. You have to know the cause of the ulcers- is it pressure, venous stasis, arterial insufficiency, or something else. Whatever the cause will determine the treatment. If you have circulatory problems, you might need surgery to improve the circulation. If you have chronic venous stasis, you might need Unna boots. You really need to see your doctor!!!

Q: Has any one used “Septiclense! on Leg ulcers on a human?
I have been suffering from a leg ulcer for at least six montjs.which has failed to clear updespite use of convential medical treatment..I have been told that the use of “Septiclense” sray as used on leg wounds scratches etc. for animals,horses goats chickens and other animals has been used to overcome this problen ?
Please help 1

A: Never a good idea to use products that are not licenced for human use.

Who is treating your leg ulcer now? Is it venous or arterial? The treatment is dependent on the origin of the ulcer. What specialist advice have you been given and have you complied with it?

If you’re going to use animal products, sack your doctor and see a vet.

Q: Fibracol for leg ulcers?
My mom has leg ulcers from poor circulation. Would fibracol be good for treatment? Is there a certain kind I should look for? If you have any more treatment suggestions PLEASE share.

A: Treatment for chronic venous leg ulceration includes:

Cleaning the wound using wet and dry dressings and ointments, or surgery to remove the dead tissue.

Specialized dressings – a whole range of products are available to assist with the various stages of wound healing.

Dressings are changed less often these days, because frequent dressing changes remove healthy cells as well as debris.

Occlusive dressings – ulcers heal better when they are covered; dressings should be changed weekly.

Compression treatment – to boost internal pressure, using either elasticised bandages or stockings. This is particularly effective if multiple layers are used.

Medications – such as painkillers, and oral antibiotics if infection is present.

Supplements – there is evidence to suggest that leg ulcers may heal faster with mineral and vitamin supplements, but only if the person suffers from a deficiency. Zinc, iron and vitamin C may be used.

Skin grafts – a surgical procedure, where healthy skin is grafted onto the prepared wound site.

Hyperbaric oxygen – this is now an accepted management option for ulcers that resist other methods of healing for example, diabetic ulcers.

Long term outlook
Unless the underlying conditions are addressed and treated, the person is at risk of developing subsequent ulcers. Options can include treatment for varicose veins, quitting cigarettes, improving the diet and taking regular exercise (such as 30 minutes of walking every day). The person should avoid hot baths, and sitting still for too long. Keeping the affected leg elevated above the level of the heart, whenever practical, can help.
______________________

Fibrocal One, was found to be superior in treatment. Here’s the article that discussed the best wound care products:

http://www.woundsresearch.com/article/2151

Read through the Johnson & Johnson site on wound care for more info:

http://jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&contentId=09008b9880ec93fd

I would also suggest calling her doctor’s office for brands that the doctor recommends. You may need to go with her to the doctor’s appointment to learn how to wrap her legs for best compression & treatment. If her leg sores are bad enough, it also may be necessary to get a Physical Therapy referral. Hope this info helps! Good luck!

Q: Can medical leech therapy help someone with infected leg ulcers (necrobiosis lapoidica)?

A: Probably not. Leeches work best to re-establish blood supply in reattached parts- they like blood, not infected skin. For that, if you are looking at alternative type therapies, you would most be interested in using something like fly larvae. They happen to like dead skin, and will not mess with healthy tissue. Medical grade ones also don’t carry disease, so won’t introduce anything new to the tissue. It’s rather gnarly to have done, though, as from what I have read the patients do feel them squiggle around, and it’s a bit squeamish to be involved with. But I think it makes sense, from a strictly medical point of view. Not sure I’d want them, but, I suppose that could change if matters justified it.

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