Why do leg ulcers take so long to heal?
Whether you have a leg ulcer yourself or are caring for a family member with a leg ulcer, one of the main questions people ask is why ulcers take so long to heal. If you graze your knee or cut your finger, it usually heals quickly and easily, so why can an ulcer take so long? The Australian and New Zealand Society for Vascular Surgery says that 1-2% of Australians will develop a leg ulcer during their lifetime, so unfortunately this is a problem many people will end up asking a vascular surgeon about. To fully understand the healing time you need to understand why people get ulcers and exactly what they are.
What is an ulcer?
An ulcer occurs when the full thickness of skin is lost from an area, usually as a result of a minor injury on top of an underlying disease process. This leaves behind a break in the skin, which is referred to as an ulcer. The characteristics of the ulcer itself depend on the cause, but you may notice weeping from the wound or changes in the skin around it. Ulcers most often occur on the lower limbs, especially around the feet and ankles. They are a common reason to be referred to a vascular surgeon, who can assess the cause and determine how best to help the ulcer heal.
What problems make you more likely to develop a leg ulcer?
The most common cause in Australia is chronic venous insufficiency. This occurs when veins are unable to efficiently return deoxygenated blood from the veins in the legs to the heart, resulting in stasis and high pressure in the veins. Ultimately, this leads to inflammatory changes and oedema in your legs, which can make it easier to cause the sort of damage that results in the skin breakdown behind an ulcer.
Arterial disease is the second most common cause. This occurs when the arteries in the leg are occluded or blocked to the point where they are unable to deliver a sufficient amount of oxygen to the tissues via good blood flow. Without oxygen and the nutrients that blood delivers, tissues will die, leaving the skin and tissue breakdown that can result in an ulcer. Arterial ulcers are generally small and often very painful.
The third most common cause of leg ulcers is actually a mix of the first two causes. Mixed arterio-venous ulcers result from both disease processes.
Why do ulcers take so long to heal?
As the full thickness of skin has been lost from the ulcer it is unable to heal like a simple graze or cut in the skin would heal. Instead, it needs to heal from the edges in. If an ulcer undergoes normal healing processes it will heal within 4 weeks and is referred to as an acute ulcer. One which takes longer than 4 weeks to heal is called a chronic ulcer. The reasons for this long time are complex.
The disease processes behind an ulcer are chronic, and the same changes that led to the ulcer make it more difficult to heal. A leg with chronic inflammation and oedema resulting from chronic insufficiency is not an ideal environment for a wound to heal, and nor is one without adequate oxygenated blood supply due to arterial disease. People who develop ulcers often have other underlying conditions such as diabetes, high blood pressure, obesity or a history of smoking, which also make their bodies less able to heal wounds. Finally, ulcers can occasionally be complicated by infection or even skin cancers.
Treating an ulcer to optimise healing is complex and requires care from a wound specialist. A careful assessment of the wound and your medical history is needed to work out exactly what the cause of the ulcer is before the best treatment plan can be developed. A vascular surgeon will be able to do this and work with you to both manage the ulcer and reduce the risk of you developing further leg ulcers.
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