Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management

Abstract

Chronic leg ulcer is defined as a defect in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Chronic ulceration of the lower legs is a relatively common condition amongst adults, one that causes pain and social distress. The condition affects 1% of the adult population and 3.6% of people older than 65 years. Leg ulcers are debilitating and greatly reduce patients' quality of life. The common causes are venous disease, arterial disease, and neuropathy. Less common causes are metabolic disorders, hematological disorders, and infective diseases. As many factors lead to chronic lower leg ulceration, an interdisciplinary approach to the systematic assessment of the patient is required, in order to ascertain the pathogenesis, definitive diagnosis, and optimal treatment. A correct diagnosis is essential to avoid inappropriate treatment that may cause deterioration of the wound, delay wound healing, or harm the patient. The researchers are inventing newer modalities of treatments for patients with chronic leg ulceration, so that they can have better quality life and reduction in personal financial burden.

Pattern of antimicrobials use in chronic leg ulcers at a tertiary care hospital

“…Additional treatment with local antibiotics had favourable outcome in wound healing rates similar with previous studies. 1,6,15 All patients in our study received AMAs empirically. 28% of the patients were prescribed with combination AMAs and the remaining patients received monotherapy with a single broad spectrum antibiotic.…”

“…5 The major risk factors being diabetes, smoking and obesity. 6,7 Optimum management of CLUs has a large impact in prevention of foot impairment and amputation rate in patients with leg ulcers. Appropriate management of these patients reduces the financial burden and improves patient's quality of life.…”

Microbiological and clinical response of superoxidized solution versus povidone iodine in the management of lower limb ulcers

“…The gender distribution was similar to other studies reported from India. [2,10] In the Western world, venous insufficiency constitutes to majority of leg ulcers, but in India, systemic conditions such as diabetes, tuberculosis, atherosclerosis, and leprosy are the main risk factors [3] The comorbid factors apart from being the cause, also adversely affect the prognosis and outcome of treatment. In this study, majority of the ulcers were diabetic.…”

“…The prevalence of leg ulceration is approximately 1-2%. [1][2][3] They affect 0.6-3% of those aged over 60 years, increasing to over 5% of those aged over 80 years due to increased risk factors for atherosclerotic occlusion such as smoking, obesity, and diabetes.…”

Use of the Diffusion of Innovation Model in venous ulcers by specialized professionals

“…In several countries, the primary etiology of these ulcers is the peripheral artery disease of lower limbs, especially venous insufficiency (1) . The latter are called venous or varicose.…”