Chapter 46 - Leg Ulcers

Abstract

Leg ulcers are a frequent medical problem associated with considerable morbidity, increasing healthcare costs, and a decrease in the quality of life of patients. Approximately 70% of leg ulcers are attributed to venous insufficiency, 20% to mixed venous and arterial disease, and 6% to arterial disease. Atypical ulcerations should be suspected when a wound presents in an atypical presentation (location, clinical features, and symptoms), or if it does not respond to standard treatment (8 to 12weeks). In this case an ulcer biopsy should be performed and tissue sent to histology, culture, and—if relevant—immunofluorescence. The pillar of treatment is a correct diagnosis, management of infection, appropriate wound dressings, and compression (if arterial insufficiency is ruled out). Adjunctive therapies are to be considered after failure of standard treatment. In cases of arterial ulcerations that can be corrected, revascularization is indicated.