By Azoma Chikwe
Many a times,an injury or a simple scratching on the leg results into a long-standing leg ulcer and if not treated adequately may result into a situation, where you have no option except loosing the leg.It is a common notion among general public that leg ulcer is generally caused by an eczema or skin disease, therefore, patients of leg ulcers more often either go to a skin specialist or a homeopath for treatment.
Some of these patients consult a general surgeon too,where a continuous process of daily dressing,and minor surgical cleanings goes on for months. All sorts of antibiotics are tried; even then leg ulcer refuses to heal.Some of these patients even go to quacks practising ancient medicines and get treated for years. It has been observed all sort of treatments ultimately fail and result into loss of foot.
Veins
Senior Consultant, Department of Cardio Thoracic and Vascular Surgery, Indraprastha Apollo hospital, New Delhi, India, Dr k.k.Pandey, said many people including educated ones in African continent ,are not aware of the fact that the leg and foot ulcers ,which do not heal over a period of time,are caused by diseases of veins in most 75 percent of cases.”Veins in our body forms a drainage system of all the four limbs and other organs of the body. Veins collect impure blood,deficient in oxygen from all the organs of the body and carry it back to the heart and lungs for purification and thus keep on replenishing the blood with oxygen.
“If this drainage system of veins becomes defective due to any reason, a large portion of the impure blood starts collecting into the legs and this leads to undue back pressure on the veins of lower limbs. If timely intervention is not initiated, it may lead to ulcers on legs and feet. These ulcers are called venous ulcers,and diseases of veins are responsible for these ulcers”.
Diseases of veins and arteries
Among the diseases of veins chronic venous insufficiency (CVI) tops the list.
The second most common cause of leg and foot ulcers is the disease of arteries. In fact, it is only artery which carries oxygen – enriched pure blood from our heart to various organs of the body including our limbs. About 20 percent cases of leg or foot ulcers,arterial disease is mainly responsible.
Pandey said, “Disease of the artery leads to narrowing of its diameter and this results into decreased supply of blood and hence less oxygen supply to various organs including leg in our body. In such a scenario, were leg is already deficient in oxygen, a simple injury in leg may lead to dangerous complications. Apparently ,a simple looking ulcer will not heal despite antibiotics and medical management and gradually over time ,will develop into a large ulcer with complications and ultimately result into amputation of foot or leg.”
Diabetes
In five per cent of cases of leg and foot ulcers, the diabetes is the culprit, the third most common cause after venous and arterial disease. There is decrease sensitivity in diabetic patients and hence,very less perception of pain due to leg and foot ulcer. “Because of this presise reason, diabetic patients tend to become less aware of the injury on their legs and feet. Hence, they become careless in management and their ulcers assumes dangerous proportions. Besides this,in diabetic patients, by and large,diseases of arteries are known to co-exist . This further jeopardises the oxygen supply of legs to a dangerously low level and will result into a non healing ulcer and gangrene of the foot.
“Blood pressure, obesity, fire burn, disease of joints like rheumatoid arthritis, anemia and infection do play an important role in the development of leg and foot ulcers.
Who to see
“If your leg and foot ulcers do not heal completely within a period of two to three weeks,immediately consult a vascular surgeon instead of a general surgeon or a plastic surgeon. The patients must visit a hospital where active and full time services of a vascular surgeon are available. Patients must ensure before entering a hospital whether the hospital is equipped with necessary and relevant investigatory facilities like Angiography, Venography,Nuclear medicine,Droppler study and Magnetic Resonance Imaging(MRI). Such patients should prefer hospitals, which provide facilities like hyperbaric oxygen therapy and were arterial and venous by pass surgical facilities including artificial grafts are available.”
What to do
What to do if you have none healing ulcer? Pandeyadvised that patients consult immediately a vascular surgeon.”Reduse your weight .Excess weight delays healing, the process of carrying deoxygenated blood from legs back to heart get slowed down. Avoid cold expose ,it is very essential to keep your legs and feet warm,room must be warm and comfortable.
“Avoid any ointment and cream,because the risk of developing eczemas over the skin surrounding the ulcer,this may hamper the healing process. There should not be any moisture over the leg and foot having ulcers. Daily cleaning of the wound is essential, leg and foot should be soaked daily,for half an hour in potassium permanganate solution before cleaning and dressing, Daily exercise of leg and foot is of utmost importance, leg ulcers are difficult to heal in a patient who remains confined in bed. Patients should avoid high heel sandals,shoes and chappals shoes must be soft and comfortable. Tight shoes do more harm than good to legs and feet,avoid walking bare footed even inside the house,it is desirable to wear soft shoes at home.
“Patients should never apply tight dressing or bandage over the legs and foot. Bandage or dressing if wrongly applied will be harmful to leg ulcer and even may cause dangerous complications.They should keep their legs elevated during the night times in bed.Put one or two pillows underneath their legs,” he said.