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Leg ulcers
AroundonepercentoftheAustralianpopulationsuffersfromlegulcers(chronicvenousleg ulceration).Themostcommoncauseispoorbloodcirculation,particularlytheinabilityoftheveins toreturndeoxygenatedbloodfromthelegsbacktotheheart.Othercausesorexacerbatingfactors includerelentlesspressure(bedsores),badlymanageddiabetes,highcholesterol,smoking, dietaryproblemsandpoorarterialcirculation.Olderpeopleareatgreaterrisk.Althoughchronic venouslegulcerationafflictsbothsexesequally,womenareslightlyover-representedbecauseof theirincreasedlifespan.Treatmentoptionsincludecompressionbandages,medication,surgery and(morerecently)hyperbaricoxygentherapy. Symptoms Thefeaturesofalegulcerinclude: Commonlyfoundonthelowerlegandankle Sunken,asymmetricallyshapedwound Edgesoftheulcerareclearlydefinedfromthesurroundingskin Surroundingskinisintact,butinflamed Surroundingskinmaybepigmented,hardenedorcalloused Yellowishwhiteexudate(pus) Pain,particularlywhilestanding Varicoseveinsintheleg.

Ima ge des crip

The calf muscle and poor circulation Generally,veinscarrydeoxygenatedbloodfromthebodytotheheart,whereitcanbesenttothe lungs.Veinshaveone-wayvalvestopreventbloodfromrunningbackwards.Thecontractionof muscleshelpstomassagebloodalongtheveins.Thecalfactsasapump,usingmuscular contractionincombinationwithdeepveinsandchamberstohelpcounteractgravityandpushthe bloodbackupthroughtheveins.Thispumpingactioncanbehinderedbyavarietyofproblems, includingblockagesinthedeepveins,venousinsufficiencyorvenousdisease.Itisnotknownhow poorveincirculationtriggersalegulcer.Onecurrenttheoryproposesthatwhitebloodcellsare trappedinsidethenarrowedcapillaries,thesmallestbloodvesselsofthecirculatorysystem.These immunesystemcellsthenattackanddestroythenearbyskintissue.Evidenceforthistheory includeshighnumbersofwhitebloodcellsandtheirby-productsfoundinthepusoflegulcers. Risk factors Anumberofdifferentfactorscanincreaseapersonsriskofchronicvenouslegulceration, including: Age-peripheralcirculationbecomeslessefficientwitholdage. Varicose veins-theone-wayvalvesthatstopbloodfromtravelingbackwardsinthevein stopworking.Thepoolingofbloodstretchesanddistortsthevein. Cigarette smoking-tobaccoisknowntoconstrictthevesselsofthecirculatorysystem. Arterial disease-veinproblemsaremorelikelyifthepersonalreadyhasother associateddiseasesofthearteries. Certain disorders-includingdiabetesandarthritis. Pressure sores-bed-boundpeopleareatriskofpressuresores,whichareareasof damagetotheskincausedbyconstantpressureorfriction. Medication-somecardiovasculardrugscancontributetolegoedemaandaltered circulation.

Treatment options Treatmentforchronicvenouslegulcerationincludes: Cleaning the woundusingwetanddrydressingsandointments,orsurgerytoremove thedeadtissue.

Legulcers

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Specialised dressings-awholerangeofproductsareavailabletoassistwiththevarious stagesofwoundhealing.Dressingsarechangedlessoftenthesedays,becausefrequent dressingchangesremovehealthycellsaswellasdebris. Occlusive dressings-ulcershealbetterwhentheyarecovered;dressingsshouldbe changedweekly. Compression treatment-toboostinternalpressure,usingeitherelasticisedbandagesor stockings.Thisisparticularlyeffectiveifmultiplelayersareused. Medications-suchaspainkillers,andoralantibioticsifinfectionispresent. Supplements-thereisevidencetosuggestthatlegulcersmayhealfasterwithmineral andvitaminsupplements,butonlyifthepersonsuffersfromadeficiency.Zinc,ironand vitaminCmaybeused. Skin grafts-asurgicalprocedure,wherehealthyskinisgraftedontothepreparedwound site. Hyperbaric oxygen-thisisnowanacceptedmanagementoptionforulcersthatresist othermethodsofhealingforexample,diabeticulcers.

Long term outlook Unlesstheunderlyingconditionsareaddressedandtreated,thepersonisatriskofdeveloping subsequentulcers.Optionscanincludetreatmentforvaricoseveins,quittingcigarettes,improving thedietandtakingregularexercise(suchas30minutesofwalkingeveryday).Thepersonshould avoidhotbaths,andsittingstillfortoolong.Keepingtheaffectedlegelevatedabovethelevelof theheart,wheneverpractical,canhelp. Where to get help Yourdoctor.

Things to remember

LegulcersaffectaroundonepercentoftheAustralianpopulation. Themostcommoncauseispoorcirculation. Treatmentoptionsincludecompressionbandages,dressingsandsurgery.

This page has been produced in consultation with, and approved by:

NorthEastValleyDivisionofGeneralPractice

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

Legulcers

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