Getting Diagnosed With A Leg Ulcer
If you have a wound or sore that isnt healing, make an appointment at your GP practice as it could turn into or be the beginnings of a leg ulcer. You might be given an appointment to see the nurse rather than the doctor as nurses are often responsible for caring for patients with leg problems.
Alternatively, there might be a Leg Club or specialist leg clinic in your area. You can attend these without having to be referred by your GP.
Remember to remove any nail polish from your toenails before your appointment.
When you see the nurse or doctor, they should:
- Ask about your symptoms and how long you have had problems
- Examine your lower legs
- Do a simple test called a Doppler ultrasound. This test compares blood flow in your ankle with that in your arm to find out if there are blood flow problems in your lower leg. You may have to come back to have your Doppler test on another day or at another clinic.
You may also be offered some other tests to check for other health problems that can affect your legs such as diabetes and anaemia.
If your GP practice thinks you have problems with your veins or arteries, they may refer you for more tests at your local hospital or specialist clinic.
You may hear different words to describe your wound such as ulcer, leg ulcer, sore, laceration, chronic wound and maybe others. Ask your nurse to explain their choice of word and what this may mean for you.
Was The Allocation Sequence Randomly Generated
Low risk of bias
The investigators describe a random component in the sequence generation process such as: referring to a random number table using a computer random number generator coin tossing shuffling cards or envelopes throwing dice drawing of lots.
High risk of bias
The investigators describe a nonrandom component in the sequence generation process. Usually, the description would involve some systematic, nonrandom approach, for example: sequence generated by odd or even date of birth sequence generated by some rule based on date of admission sequence generated by some rule based on hospital or clinic record number.
Unclear
Insufficient information about the sequence generation process to permit judgement of low or high risk of bias.
Description Of The Condition
Venous leg ulcers are chronic wounds on the lower leg caused by poor venous return from the feet to the heart . They usually affect older people, with some estimates that up to 1% of people will be affected by a leg ulcer at some point in their life in industrialised countries with higher prevalence in females aged over 70 years . The average cost of treating a venous ulcer with dressings varied between 1332 and 2585 in Sweden and between 814 to 1994 in the United Kingdom . The costofillness of leg ulcer treatment in Hamburg revealed mean annual total costs of 9060/patient/year and associated high costs of leg ulcers for health insurances, patients and society . The prevalence in less industrialised countries is not fully described as yet, but it is likely that venous ulcers may also affect people across settings. Leg ulcers usually take months to heal completely and often recur after healing. Some people are affected by venous ulcers for many years and the leakage of wound fluid from the ulcer, smell, itch and pain can reduce quality of life and self image, and occasionally lead to low mood and depression .
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Always Wear Your Compression Bandage
A compression bandage is a thin elastic stocking or wrap that is worn over the dressing. It is designed to improve the circulation of the blood in your legs. Improved circulation helps your wound to heal.
Wearing a compression bandage when you have a leg ulcer is extremely painful. It is so painful that many people dont follow through with wearing it as instructed. Failing to wear your compression bandage as instructed will prolong the length of time it takes your leg ulcer to heal.
Were Incomplete Outcome Data Adequately Addressed
Low risk of bias
Any one of the following:
- No missing outcome data.
- Reasons for missing outcome data unlikely to be related to true outcome .
- Missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups.
- For dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate.
- For continuous outcome data, plausible effect size among missing outcomes not enough to have a clinically relevant impact on observed effect size.
- Missing data have been imputed using appropriate methods.
High risk of bias
Any one of the following:
- Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups.
- For dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate.
- For continuous outcome data, plausible effect size among missing outcomes enough to induce clinically relevant bias in observed effect size.
- ‘Astreated’ analysis done with substantial departure of the intervention received from that assigned at randomisation.
- Potentially inappropriate application of simple imputation.
Unclear
Either of the following:
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Caring For Venous Wounds And Ulcers
When the legs are said to have vein disease, they are predisposed to developing venous ulcers, chronic pain, and pain. These ulcers may alter your movements because a lot of pain is felt when walking.The Villages venous ulcers are usually treated and managed by a specialist who uses evidence-based practice in caring and treating the ulcers.
What are venous ulcers and wound care?
In most cases, venous ulcers usually arise as a complication of venous disease. The ulcerations on the legs are painful and irritating chronic sores that produce some fluid. They are mainly found below the cuffs on the lower legs sides, on foot or ankle bone.
A purple, dark, and reddish-brown skin discoloration are the primary indication of a venous ulcer. In most cases, your skin usually feels firm and dry. You might also observe some chronic swelling around your ankle, and the legs may feel itchy and exhausted. Suppose these symptoms are not treated they may result in the development of venous ulcers. However, the specialists and experts in the facility play an essential role in preventing ulcer formation or breaking your skin.
After some time, both the fluid and red blood cells leak out of the veins into adjacent tissues. Therefore, it causes further damage to your skin, making it very thick, dark, and dry. In case your skin experiences any trauma that breaks your skin open leads to the formation of a venous ulcer.
Preparation Of Activator Solution
Activator solution was prepared by combining human thrombin with 1% Calcium Chloride in the ratio of 1:9, respectively. The combination of Thrombin and Calcium Chloride activates platelets in just fraction of seconds resulting in fibrin matrix formation. Depending upon the wound area, 2-3 mL of activator solution was prepared in the sterile field and kept aside for application along with PRP. Calcium chloride nullifies the effect of the acid citrate anticoagulant used, and thrombin helps in activating fibrinogen, which is converted to fibrin and cross-linked .
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Can Venous Leg Ulcers Be Prevented
There are several ways to help prevent a venous leg ulcer in people at risk, such as:
- wearing compression stockings
- losing weight if you’re overweight
- exercising regularly
- elevating your leg when possible
This is particularly important if you’ve previously had a leg ulcer once a leg has suffered a venous ulcer, you’re at risk of further ulcers developing within months or years.
Read more about preventing venous leg ulcers.
Home Remedies For Arterial And Venous Ulcers:
Healing poultice: place a little bit of extra-virgin olive oil and oil drop of liquid chlorophyll in some dressing and gently apply to the wound.
- MORE IN THE JOY OF WELLNESS Show Off those Perfect Legs
Kale remedy: cut the kale into small pieces and mix two tablespoons of kale with one cup of oatmeal tea . Moisten the kale in the hot tea and after it has cooled, moisten the wound with it.
Healing juice for ulcers: blend 20 well-washed carrots in the blender and two cups of cabbage with one cup of alfalfa sprouts. Sip the juice slowly while eating.
Green tea or ginkgo infusions will help promote good circulation. Drink two or three cups 20 minutes after eating.
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Diagnosis Of Leg Ulcers
- examine the wound
- perform some tests to measure the blood flow in your lower leg, such as the ankle-brachial index. This test compares blood pressure readings taken at the ankle and at the arm using a device called a Doppler machine
- recommend an angiogram for an arterial ulcer, to find out if the artery needs surgery to clear the blockage.
What Is An Ulcer
When your stomachâs healthy, itâs coated in a layer of sticky mucus. This protects it from the harsh acid that breaks down your food. If something upsets this balance, you end up with more stomach acid and not enough mucus. Over time, that acid gnaws away at the tissue that lines your stomach. The painful and sometimes bloody open sore it causes is called an ulcer. Some are tiny, while others are over an inch long.
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What Are Pressure Ulcers
Pressure ulcers are a type of wound caused by prolonged pressure being applied to an area of skin which starves the blood supply. This leads to damage of the skin and tissues below. Pressure ulcers commonly affect people that are bedbound or immobile and so are often called bed sores, pressure sores or pressure damage.
Medical History And Examination
Your GP or practice nurse will ask whether you have any other symptoms associated with venous leg ulcers, such as:
- swelling in your ankles
- discoloured or hard skin
They’ll try to determine the cause of the ulcer by asking about underlying conditions or previous injuries, such as:
Read more about how venous leg ulcers are treated.
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Other Tips For Helping Leg Ulcers Heal Faster
In addition to always following the instructions provided for how to dress the wound and how to wear your compression bandage, there are other things you can do to help speed up the healing of your leg ulcer. Other things you can do include:
- Take any and all medication as prescribed for your leg ulcer
- Keep your leg elevated as much as possible. The leg should be elevated at a height that is level with your eyes.
- Stay active. Simply walking each day can help prevent the leg ulcer from getting worse and reduce the amount of swelling you experience in your legs.
- Learn stationary leg exercises that you can do throughout the day. Some examples of stationary leg exercises include rotating your ankles, moving your feet up and down, or wiggling your leg. These exercises will help to improve blood flow to your legs.
- Try to lose weight
- Seek treatment for any other health problems, such as diabetes or heart disease
- Make improvements to your diet
- Work to make lifestyle changes, such as not drinking too much alcohol and not smoking
- Avoid bumping or touching the wound as it could reinjure the area and slow down the healing process
- Follow through with all regularly scheduled appointments with your doctor and healthcare team
Arterial And Venous Ulcers
Arterial ulcers make up approximately 20% of all foot and leg ulcers, and 70% are venous ulcers. Arteries are conducts that transport blood from the heart and spread in through all the bodys tissues. These tissues feed on the oxygen and nutrients brought to them in the blood.
Once the blood is used, it is filled with waste products, like carbon dioxide. This blood returns to the heart though the veins . When arterial blood does not circulate efficiently because the arteries have stretched, perhaps from arteriosclerosis for example, the blood begins to pool and tissues are affected. The majority of venous ulcers are caused because the valves that connect superficial veins with deep veins no longer function properly.
Arterial and venous ulcers usually affect the legs, the feet, the heels, and toes, and they can be very painful.
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Seek Treatment For Existing Vein Conditions
If youre currently experiencing the symptoms of venous insufficiency such as spider veins, varicose veins, leg aching & heaviness, leg ulcers, eczema, etc., book a free screening with our vein specialists. We offer personalized treatment plans based on your condition and unique needs.
While eating healthy is important for vein health, letting existing vein problems untreated can lead to more health serious conditions.
All of our 10 vein clinics are specialized in treating vein diseases. We use the most advanced technology such as EVLA, sclerotherapy, Varithena, ambulatory phlebectomy.
Book a FREE Screening with our vein clinic to learn about your risk factors, lifestyle changes, vein health and payment options.
Blinding Was Knowledge Of The Allocated Interventions Adequately Prevented During The Study
Low risk of bias
Any one of the following:
- No blinding, but the review authors judge that the outcome and the outcome measurement are not likely to be influenced by lack of blinding.
- Blinding of participants and key study personnel ensured, and unlikely that the blinding could have been broken.
- Either participants or some key study personnel were not blinded, but outcome assessment was blinded and the nonblinding of others unlikely to introduce bias.
High risk of bias
Any one of the following:
- No blinding or incomplete blinding, and the outcome or outcome measurement is likely to be influenced by lack of blinding.
- Blinding of key study participants and personnel attempted, but likely that the blinding could have been broken.
- Either participants or some key study personnel were not blinded, and the nonblinding of others likely to introduce bias.
Unclear
- Insufficient information to permit judgement of low or high risk of bias.
- The study did not address this outcome.
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Symptoms Of Leg Ulcers
- that they are commonly found on the lower leg and ankle
- a sunken, asymmetrically shaped wound
- the edges of the ulcer are clearly defined from the surrounding skin
- the surrounding skin is intact, but inflamed
- the surrounding skin may be pigmented, hardened or calloused
- yellowish-white exudate
- varicose veins in the leg.
Treatment What Treatment Will I Be Offered For My Leg Ulcer
If your wound isnt healing because of venous hypertension and there are no problems with the blood supply to your legs, then you should be offered compression therapy.
Compression therapy improves blood supply by applying pressure to the leg. This can be done by bandaging the lower leg or by wearing supportive socks, stockings or tights. Compression therapy is very effective at reducing swelling, improving blood flow in the veins and healing or preventing sores or ulcers.
There are lots of different types of compression therapy so ask your nurse to find something that is right for you.
Compression can be a little uncomfortable when you first start treatment but should not cause you any pain. Any discomfort should reduce as the swelling goes down. If you do experience discomfort, talk to your nurse or doctor about it and they will advise you on ways of alleviating this.
In addition to the compression, your nurse should also advise you on wound care and dressings to keep your wound healthy.
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How Do Wounds Occur
Wounds occur when the skin is broken or damaged through injury or surgical incision. The skin can be damaged in a variety of ways depending on the cause of the injury e.g. trauma pressure or friction . The lower limbs in particular can be prone to diabetic and venous ulcers which may have started with trauma or through repeated irritation which combined with poor blood circulation results in skin damage.
Getting A Specialist Vascular Referral
If you have venous hypertension, intervention to your veins from a vascular specialist might help with healing and stop your wound or sore from coming back. Sometimes varicose veins can be treated by laser therapy. If you have peripheral arterial disease, you may require further investigations and the vascular team will be able to assess the need to improve the blood supply to your leg or whether your ulcer can be managed in other ways such as reduced/modified compression. Ask your nurse or doctor for a referral to your local vascular team to talk about how their input might help you.
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Bread And Baking Soda
I have a new leg uler which developed after a bleed. It is on my interior ankle. Extremely painful. Can feel the swelling where the damage was done. I was told of a method using bread, bicarbonate of soda on the bread and water which makes the paste bubble. Does anyone know of this method. Surelly there is some native bush remedy out there. Indigenous people have cures for all their needs which they have used for years. Modern wound clinics just put on a bandage and say see you nexst week. One year later you are still doing the same thing.
Some years ago I was given a radical idea to try. At the time I didn’t take any notes etc but it worked! I had 5 cellulitis ulcers on one leg and I was told to drink 1/4 cup of Colloidal Silver every 5 hours and spray my leg frequently with same. To do it over a 24 hour period. I did it and within 10 days I had only had the original ulcer left. Which hasn’t been oozy for years.
So in that time frame, I lost 4 ulcers that have never returned. In 2017, one of my 2 specialists told me to use potassium permanganate to wash my legs daily and use the amount of crystals that would barely fit on the edge of a matchstick… He told me it kills sepsis and pseudomonas. Other Dr was delighted and told me that before the arrival of penicillin, doctors used Condy’s Crystals as a wash for ulcers.
HoneyHoney