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For Your Patient: What is a Chronic Leg Ulcer?

Information Every Patient Should Know About Chronic Leg Ulcers

The following information is offered by KCI as a general educational resource for your patients with Chronic Leg Ulcers. Let us help you provide your patients with information that will help them better understand their chronic leg wounds, how to manage them, and about V.A.C.® Therapy if you choose to prescribe it.

What is a Chronic Leg Ulcer?

A chronic leg ulcer or 'open leg ulcer' is a wound on the lower part of the leg that does not heal within a reasonable period of time. Normally, a wound should heal within one to three weeks. However, when a wound persists for a period longer than 4 to 6 weeks most health care providers term it a chronic wound.

Chronic leg ulcers mainly have their basis in a malfunctioning of the blood vessels of the leg. Either the blood supply is reduced, leading to a so called 'arterial leg ulcer', or the blood return transport is reduced causing a 'venous leg ulcer'. Sometimes there is a combination of reduced blood supply and reduced blood return. Than we speak about a 'mixed ulcer'.

Over 70% of all diagnosed chronic leg ulcers are Venous Leg Ulcers so the information below concentrates on these.

How is blood return working?

In a normal functioning, healthy person the blood is transported by the heart through the body and also into the legs, traveling through blood vessels. The blood vessels transporting blood from the heart to the body are called arteries. Blood is transporting oxygen and other compounds (like sugar) that the body needs to function properly. When the blood has delivered its oxygen and energy (sugar) to the tissues it is returned back to the heart. These return blood vessels are called veins. The return blood flow is also called venous return.

In cases of problems with the arteries, the blood has difficulty in reaching the organs. When the blood has difficulties returning to the heart, this is mainly due to a malfunctioning of the veins.

When veins are not functioning well the blood fluid has problems returning from the leg to the heart. Very often fluid is retained in the legs and this makes the legs increase in size – this is called 'edema'. As a result of this reduced blood return, the health of the tissue in the legs deteriorates. So, for example, if somebody hits their leg against a chair or a table, the leg can be damaged and a small wound will develop.

How can a leg wound heal?

Under normal conditions when a leg wound happens the blood brings healing cells and chemical compounds to the wound. These will help the wound bed to heal. Compounds that can inhibit wound healing will be brought away from the wound via the venous blood return. In other organs, such as the liver, the blood will be cleaned up again. When the venous blood return is malfunctioning there is limited efficiency in the wound healing process and as a consequence of that it can take longer than normal before a wound heals.

When the wound persists for a longer period of time it gives bacteria the opportunity to start growing. Presence of bacteria reduces the efficiency of the wound healing process. So when a wound is not healing well, it is important that health care professionals clean the wound thoroughly before any dressing application.

When the wound bed is cleansed thoroughly, the health care professional will choose an appropriate dressing. The choice of dressing is dependent on the amount of exudate coming out of the wound, the size of the wound and the presence (or absence) of bacteria.

In addition to the dressing, it is very important that the body gets help to return blood from the veins to the heart. To do this, a bandage is wrapped around the leg tightly to provide compression. When the patient is actively using the compression-bandaged leg (by walking, for example) the blood is stimulated to flow out of the leg veins to the heart. This helps the exchange of blood and with it the exchange of compounds helping to heal the wound.

What is V.A.C. Therapy and why is it used on leg ulcers?

V.A.C. Therapy stands for Vacuum-Assisted Closure Therapy; this is a specific technique where negative pressure (vacuum) is used to stimulate the body's healing process. V.A.C. Therapy consists of a dressing/foam (either grey or white), a film drape and a pump unit. It is designed to pull wound fluid (exudate) from the wound – transported via a tube – into a canister. This continuous negative pressure stimulates the blood flow to the wound bed. The foam has a specific structure which helps cells to start growing. The negative pressure also stimulates the process of cell division. This process of new cell and tissue formation is called granulation tissue formation. Granulation tissue at the wound bed looks healthy and is a sign of healing. V.A.C. Therapy has been demonstrated to be effective in wound healing in general, and specifically in the healing of venous leg ulcers.

V.A.C. Therapy can be used in combination with bandaging of the leg and this combination of two treatments is even more successful than using either treatment alone.

Your health care professional will inform you which treatment is best to help your wounds heal. If you have any questions, always feel free to put them to to him/her.

Last but not least, even when it may seem better to sit down and rest the wound, it has been shown that staying active is a much better option. By regularly taking short walks you stimulate the blood circulation through your leg. This brings healthy compounds to start healing the wound, while the compounds that inhibit the wound healing are transported away.

If you want to use vitamins or other compounds that could have a beneficial wound healing effect, always discuss this with your health care professional. They know your wound and know if specific extra treatments could be of help.


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