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Leg ulcers Q&A

What is arterial disease and how do I know if it is affecting me?

Peripheral arterial disease (PAD) is a common condition where a build-up of fatty deposits in the arteries restricts blood supply to leg muscles. It is also known as peripheral vascular disease (PVD).

Many people with PAD have no symptoms. However, some develop a painful ache in their legs when they walk, which usually disappears after a few minutes' rest. The medical term for this is "intermittent claudication".

The pain can range from mild to severe, and usually goes away after a few minutes when you rest your legs.

Other symptoms of PAD can include:
  • hair loss on your legs and feet
  • numbness or weakness in the legs
  • brittle, slow-growing toenails 
  • ulcers on your feet and lower leg that are deep, dry, and painful
  • changing skin colour on your legs, such as turning pale or blue
  • shiny skin 
  • the muscles in your legs shrinking (wasting)
The symptoms of PAD often develop slowly, over time. If your symptoms develop quickly, or get suddenly worse, it could be a sign of a serious problem requiring immediate treatment.

Risk factors include:
  • smoking – the most significant risk factor
  • type 1 diabetes and type 2 diabetes
  • high blood pressure
  • high cholesterol
During you lower limb assessment including Doppler your healthcare professional will assess for PAD.

What are the signs of a wound infection and how is it treated?

All open wounds have colonisation of bacteria, this is normal and does not usually cause any problems. Coving wounds with a suitable moist dressing will ensure a good healing environment along with compression therapy.

If the bacteria move deeper into the wound, it can grow faster and overwhelm the immune system, this is known as local infection. The wound is infected and may show signs of more leakage, odour, pain, redness and swelling of the skin surrounding the wound edges. The wound may get larger and deteriorate at this stage and the infection will require a topical management in the form of an antimicrobial or antiseptic dressing. Your healthcare professional will advise you what type of dressing is suitable, it may consist of honey, iodine, silver, enzymes, or bacterial binding there are various types available. Compression can continue with a wound injection and will need monitoring with your supported self-care.

If spreading infection occurs, which can affect further into the skin layers and beyond, a person may also feel unwell, have a high temperature and extended redness and warmth of the skin spreading away from the wound. Antibiotics are indicated at this point with the antimicrobial type of dressing. Compression can continue but it depends on a pain levels and toleration of that.

Systemic infection of sepsis is where the infection has spread widely through the body, it is serious and can affect the organs ad even result in death. Urgent medical attention is required for signs and symptoms of sepsis such as lethargy, loss of appetite and feeling unwell.

With the overuse of antibiotics in the world there is now an antimicrobial stewardship, this calls for appropriate prescribing of them only when true infection is present. A wound swab may be taken to determine the right antibiotic for your infection treatment.

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

No. There has been research undertaken on this as long ago as the 14th century and it all concludes that a moist environment gives the best wound healing environment. When moist it encourages the wound edges, the new top layer of skin to migrate and close the wound edges together which then creates scar tissue. If left open to the air the wound might scab over, but it is not healed underneath. Also, it is an opening for more bacteria and outside elements to cause infection.

Will compression be painful to wear? 

The ulcer and venous insufficiency to your leg can make it painful and that can limit what you can do day to day and affect our well-being overall. Getting the right compression for you is key, and once this therapy is working then your ulcer and symptoms will improve and the pain will reduce.

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, compression and vascular procedures 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.