Leg ulceration is an extremely common problem affecting about 1-2% of the general population in the UK.
Most leg ulcers are venous in origin; this means that they are caused when there is a problem with blood returning to the heart. Every time your leg muscles move they help pump the blood back towards the heart while a series of valves in your veins stop the blood from flowing backwards.
The problem starts when these valves become damaged and are unable to prevent the backflow of blood. This causes an increase in pressure in the veins in the lower leg which forces fluid and blood cells to leak through the walls of small blood vessels called capillaries into the surrounding tissue.  This leakage is toxic to the skin and causes it to break down, resulting in ulceration. 
















Elevation:
This is one of the most important aspects of the treatment of your leg ulcer.  Elevating your legs to above the level of your heart encourages the blood to return to the heart and reduces backflow in the veins. This greatly enhances the healing process.

There is no point in elevating your legs on a stool while sitting in a chair as this will not help the blood to return to your heart and so you will be wasting your time. High elevation as shown in the picture above is the only effective way to help the blood return to your heart.  

We would advise you to elevate your legs in this position for at least two hours in the morning, afternoon and evening, a total of six hours a day minimum.  This will often mean quite a change to your normal daily routine, but it is well worthwhile. 

Compression bandages:
After a full assessment at the leg ulcer clinic, your treatment will be explained to you, which will involve wearing compression bandages. These bandages aid healing by gently squeezing the blood up the veins in your leg, thereby preventing backflow and swelling. 

Multi-Layer Compression Bandages













3.The bandages are comfortable even on the most difficult shaped limb. They are flexible should not hinder your walking.

4.The cotton wool layer is the only layer that comes into contact with the skin and this is made from natural fibres.  This reduces the risk of allergy.

These are just some of the benefits of multi-layer bandaging.
 
It is now widely accepted that graduated multi-layer compression is the most effective treatment for faster healing of venous leg ulcers.

Whatever bandages are used, they should normally be left in place for one week and should feel comfortable, firm and supportive but not too tight.  If you experience any of the following symptoms deatiled below, you should remove the outer bandage and seek advice from your community nurse. GP or one of the specialist nurses at the leg ulcer clinic. If you experience these symptoms out of normal surgery hours, you should contact your on call district nurse or your local Primary Care Centre:







Compression hosiery:
You will be asked to wear graduated compression hosiery once your leg ulcer has healed. These stockings / socks are designed to gently compress the lower leg. This pressure gradually decreases from the ankle to the knee, helping the calf muscle to pump the blood back towards the heart.

It is extremely important that you continue to wear your stockings at all times during the day once your ulcer has healed as it will reduce the risk of having another leg ulcer.

Pinch skin grafts:
Having pinch skin grafts can both start and speed up the healing process in an ulcer without much disruption to normal life. They are little pinches of your own skin taken from an area on your outer thigh under local anaesthetic and planted into the ulcer. Here they will hopefully grow and help to close up the ulcer site.

Sterile maggots may be used as an adjunctive treatment to clean open wounds that are infected or contain sloughy (dirty) or necrotic (dead) tissue.
Another adjunctive treatment may be taking a biopsy – the removal under local anaesthetic of a small sample of skin, which is then examined under a microscope to check for significant changes in the skin or wound.

Exercise:
Keeping active is another important function to healing your ulcer.  The action of walking causes the calf muscle to squeeze the veins and pump the blood back towards the heart.  Without this pumping action, all the blood will continue to collect in your legs due to gravity.

Try to avoid standing for long periods of time, for example - ironing, cooking and washing-up.  If you do find yourself in a situation where you need to stand, try walking briskly on the spot or lifting your heels as this will help to keep the blood circulating.








Treatment
Leg ulcers can appear spontaneously or as a result of a slight injury to the leg.  Either way, they are defined as an ulcer if they fail to heal within 4 - 6 weeks.  In recent years, there has been a lot of research into the treatment of leg ulcers and this has resulted in more ulcers healing and remaining healed than in the past.  The main reason for this success is the development of new techniques in assessment.
Only after a thorough assessment of the underlying circulation in the leg can appropriate treatment be decided upon.  This will be aimed at treating the cause rather than just the wound itself.  Appropriate treatment for leg ulcers caused by poor circulation in the veins is aimed specifically at helping those veins to move blood back up the leg more effectively


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Leg ulcer
Application of multi-layer bandages
The multi-layer system is the “gold standard” treatment for venous leg ulcers and has been designed with comfort, as well as healing, in mind.
Here are some of the reasons for the multi-layer bandage system:

1.The system allows the compression to be gradually increased, rather than wearing one very tight bandage, to reach the correct compression levels.

2.The dressing will only need to be changed once a week in most cases. If your ulcer is very wet this may need to be twice a week.
Futher information
The information contained on this website is intended as a guide only, it is not intended to subtitute for medical consultation, diagnosis or treatment.
Please see your doctor with any questions regarding personal health or medical conditions

Multi-layer compression bandaging
Leg ulcer

Leg ulcer
· Pins and needles
· Blue or white coloured skin on your toes
· Swelling in your toes
· Unusual pain in your leg, foot or toes
· Excessive itching, burning or irritation
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