Non diabetic chronic leg ulcers: etiology and management

Abstract

Background: Chronic leg ulceration has varied etiologies and a systemic approach towards its pathogenesis, definitive diagnosis and optimal treatment is the need of the hour. Paucity of research data on non-diabetic chronic leg ulcer becomes the rational of present study.Methods: Total number of 60 patients with non-healing ulcer below knee and above ankle for more than 6 weeks duration were included in this observational study. A detailed clinical presentation, relevant biochemical, microbiological and imaging investigations were recorded. The management of these ulcers was based on its etiology with an approach to conservative management (antibiotics, daily dressings, improvement in nutritional status) to surgical debridement, wide local excision followed by split thickness/full thickness skin grafting. Outcome of present study was in terms complete or partial healing of ulcer, persistence or recurrence of ulcer.Results: Majority of patients (28.33%) with chronic leg ulcer presented during sixth decade with a male to female ratio of 5:1. The mean duration of chronicity of ulcer was 17.75 months with standard deviation of 7.83 months. Trauma was the commonest etiological factor (45%) followed by venous insufficiency (31.66%). About 31.66% of ulcers were managed conservatively and 68.32% by surgical procedure. Complete healing rate was found in 66.67% patients, persistence of ulcer in 18.32%, partial healing in 11.67% patients and 1.67% patient showed recurrence.Conclusions: Trauma and venous etiology were commonest cause of chronic leg ulcer. A comprehensive etiological assessment and judicious use of conservative or surgical therapy are pivotal in management of these ulcers.