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Prevention and treatment

Venous and arterial leg ulcers

Chronic wounds often manifest as ulcers on the lower legs caused by chronic venous insufficiency and/or peripheral arterial occlusive disease in the majority of cases. Leg ulcers affect about 1 in 1000 people in Europe and are more frequent in elderly people: A british study revealed that the average age of people with venous leg ulcers was 73.5 years old.

According to an estimation about 80% of chronic wounds localized on the lower leg are the result of chronic venous insufficiency, whereas in 5-10% the cause is of arterial etiology. Other etiologies, like neuropathic ulcers represent the remaining percentages.

If not treated correctly, a leg ulcer can become a chronic wound which requires longer healing time, sometimes more than six months, and they have a tendency to reoccur.

Venous leg ulcers

The cause of venous leg ulcers is venous insufficiency due to damage in the valves resulting in hypertension, retrograde blood flow and/or obstruction in the calf veins. All this is responsible for the dermatologic and vascular complications.

Venous leg ulcers can be painless, but some are very painful. They can become infected. There is often an inflammation (dermatitis) around the infected venous leg ulcer.

Risk factors are:

history of venous leg ulcer
history deep vein thrombosis and or varicosis
older age
family history of venous leg ulcer

Prevention and intensive management are key in venous leg ulcer treatment, especially because the recurrence rates of up to 17% at one year is challenging. Therefore, numerous guidelines have been developed but unfortunately some heterogeneity among the guidelines exist. However, mostly consensus could be achieved:

A multidisciplinary approach involving, e.g. vascular surgeons, angiologists, primary care physicians and nurses is preferred.
Taking a detailed history and a performing a comprehensive physical examination are universally discussed.
Compression therapy, topical treatments, dressings, antimicrobials are universally discussed.