Leg ulcers Q&A

The clinician identifies arterial disease in the leg

This is a dangerous situation if it is not addressed.  Arterial disease is particularly common in patients who smoke or those with diabetes.  The clinician cannot correct the problem without the help of a vascular consultant.

The vascular consultant can often correct the disease and when they do, the ulcers will undoubtedly heal.

The clinician identifies a clinical infection

There are more bacteria on a person than there are people on earth.  This means that any wound that is delayed from healing will have bacteria in it - this is called 'colonisation' and is often not a problem.  However, the bacteria reproduces every 20 minutes and can begin to cause an odour and may even begin to break the wound down further.  The clinician in the Leg Club will know what to do and will use an 'antibacterial' dressing such as honey, iodine cadexomer or silver dressings.  These will reduce the bacteria in the wound. 

For colonisation, it is wrong to prescribe antibiotics as the bacteria protect themselves on the surface of the wound and antibiotics cannot reach them.

Clinical infection is where the bacteria has entered the body instead of just sitting on the surface of the wound.  There is likely to be spreading redness around the wound, an increase in pain in the wound, an increase in odour and there may be a temperature.  This is when antibiotics are required as the dressing cannot reach the inside of the body.

The wound is losing a great deal of fluid

This is likely to be associated with venous disease.  When the veins become engorged, they begin to let fluid escape into the wound and this increases the fluid loss.  Also, when the legs are down, gravity will take more fluid down into the feet, causing higher fluid loss.  Compression therapy will always be the answer to this problem.

Another reason for fluid loss is the bacteria that is in the wound.  This causes the veins to increase in size and that permits increased fluid loss.  Antibacterial dressings such as honey, iodine cadexomer and silver will help to remove the bacteria.

The wound has a strong odour

The odour and discolouration in a wound is the result of bacteria in a wound.  The colour should alert the clinician to the type of bacteria and each bacteria has an odour and signs of its own.  The answer is simple.  Removal of bacteria is with antibacterial dressings and antibacterial fluids.
Washing with saline will not help.

What dressing should be used on a leg ulcer?

There are over 3,000 dressings on the market so selection is difficult.  However, there is a very simple rule of thumb: A wet dressing for a dry wound; a dry dressing for a wet wound; an antibacterial dressing for one that has an odour; a superabsorbent for a very wet wound and a foam to protect a healing wound.
The exceptions would be an arterial wound or a wound on someone who is end of life.  These should be protected with a simple dry dressing.

Would leaving the wound open to the air help to heal the wound?

Definitely not.  As long ago as the 15th century, Gaelon said that moist wound healing was essential.  Winter informed us of his research on wound healing in 1962, when he found it takes 7 days longer for a 'dry' wound to heal than one dressed with a moist environment.

Mother and grandmother had ulcers that never healed.

We have all heard the terrible stories and seen how wounds can go on for years. However, clinicians in the Leg Clubs are highly educated in how to heal wounds and can heal those who have had wounds for years. 
The modern use of dressings and compression will always help those with venous ulcers.

Those with arterial ulcers require a more specialised help to heal their ulcers and will visit the vascular team.