Leg ulcers

Leg ulcers

12 In developed countries, the most common chronic wounds It are leg ulcers. An ulcer can be defined as a break in the epithelial continuity . A prolonged inflammatory phase leads to overgrowth of granulation tissue and attempts to heal by scarring leave a fibrotic margin. Necrotic tissue, often at the - ulcer centre, is called slough. The more common aetiologies are listed in Summary box 3.7 . A chronic ulcer that is unresponsive to dressings and simple treatments should be biopsied to rule out neoplastic change, a squamous cell carcinoma known as a Marjolin’s ulcer being the most common. E ff ective treatment of any leg ulcer depends on treating the underlying cause , and diagnosis is therefore vital. Arterial and venous circulation should be assessed, as should sensation throughout the lower limb. Surgical treatment is only indicated if non-operative treatment has failed. Summary box 3.7 Aetiology of leg ulcers /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Vascular (venous, arterial, mixed) Trauma (bites, self-in /f_l icted, burns) Infection (bacterial, fungal, mycobacterial, syphilis) Metabolic disorders (diabetes mellitus, gout, calciphylaxis) Autoimmune disorders (vasculitis, systemic sclerosis, rheumatoid arthritis) Neoplastic (squamous cell carcinoma, basal cell carcinoma)

Leg ulcers

12 In developed countries, the most common chronic wounds It are leg ulcers. An ulcer can be defined as a break in the epithelial continuity . A prolonged inflammatory phase leads to overgrowth of granulation tissue and attempts to heal by scarring leave a fibrotic margin. Necrotic tissue, often at the - ulcer centre, is called slough. The more common aetiologies are listed in Summary box 3.7 . A chronic ulcer that is unresponsive to dressings and simple treatments should be biopsied to rule out neoplastic change, a squamous cell carcinoma known as a Marjolin’s ulcer being the most common. E ff ective treatment of any leg ulcer depends on treating the underlying cause , and diagnosis is therefore vital. Arterial and venous circulation should be assessed, as should sensation throughout the lower limb. Surgical treatment is only indicated if non-operative treatment has failed. Summary box 3.7 Aetiology of leg ulcers /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Vascular (venous, arterial, mixed) Trauma (bites, self-in /f_l icted, burns) Infection (bacterial, fungal, mycobacterial, syphilis) Metabolic disorders (diabetes mellitus, gout, calciphylaxis) Autoimmune disorders (vasculitis, systemic sclerosis, rheumatoid arthritis) Neoplastic (squamous cell carcinoma, basal cell carcinoma)

Leg ulcers

12 In developed countries, the most common chronic wounds It are leg ulcers. An ulcer can be defined as a break in the epithelial continuity . A prolonged inflammatory phase leads to overgrowth of granulation tissue and attempts to heal by scarring leave a fibrotic margin. Necrotic tissue, often at the - ulcer centre, is called slough. The more common aetiologies are listed in Summary box 3.7 . A chronic ulcer that is unresponsive to dressings and simple treatments should be biopsied to rule out neoplastic change, a squamous cell carcinoma known as a Marjolin’s ulcer being the most common. E ff ective treatment of any leg ulcer depends on treating the underlying cause , and diagnosis is therefore vital. Arterial and venous circulation should be assessed, as should sensation throughout the lower limb. Surgical treatment is only indicated if non-operative treatment has failed. Summary box 3.7 Aetiology of leg ulcers /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Vascular (venous, arterial, mixed) Trauma (bites, self-in /f_l icted, burns) Infection (bacterial, fungal, mycobacterial, syphilis) Metabolic disorders (diabetes mellitus, gout, calciphylaxis) Autoimmune disorders (vasculitis, systemic sclerosis, rheumatoid arthritis) Neoplastic (squamous cell carcinoma, basal cell carcinoma)