How Do You Treat a Leg Ulcer?

QUESTION: I'm sixty-five and I've recently developed a leg ulcer that my
doctor told me was caused by my "bad veins". What are some methods of
treatment and preventing another one?
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ANSWER: I'll give you some information as I recount the history of a recent
patient of mine, who also suffered from venous ulcers. Marie was a
grandmother with five grandchildren. She had spent a large part of her life
as a packer in an aeronautics plant, and she also had a history of
hypertension. She visited my office and upon examining her feet and legs I
noticed a patch of scaly, discolored skin on her calf. I immediately
suspected the beginning of a pattern that could lead to a leg ulcer because of
her hypertension and former occupation. People at higher risk for venous leg
ulcers are those over sixty-five, obese people, women who have had children,
and those with some of the accompanying diseases of old age like hypertension,
diabetes, other cardiovascular disease. Smoking is a great risk factor in leg
ulcers. Also people who must stand on their feet a great deal with little
opportunity for moving about seem to be afflicted. And then there is the
natural aging process--the skin loses its ability to heal, plus swelling, poor
circulation, and inadequate nutrition all lead to the skin being easily
injured.
I explained to Marie that this type of leg ulcer develops when the deep
veins are not performing properly, and the surface veins become blocked and
cause a lack in blood supply. This is the reason for the discoloration and
tissue death deep in the leg. Beside the discoloration, other warning signs
are scaling and a shape to the leg reminiscent of an upside-down champagne
bottle--wide in the calf and very narrow in the ankle. Some actions can be
taken to reduce the risk of developing another leg ulcer. Wear support
stockings everyday as soon as you get up in the morning. Watch you legs
carefully for any changes in the skin texture and color. Do give up smoking
if you haven't already done so. Lose weight if you are overweight. Try to
keep your feet at about the level of your heart while sitting and raise the
end of your bed so feet and heart are about the same level when you sleep.
These precautions are also the therapy for existing leg ulcers. Also,
never put an over-the-counter ointment on your leg ulcer; this could cause a
severe allergic reaction; your dressing must be changed about once a week. If
there is a leakage of pus, return to your doctor who will change the dressing
and lessen the risk of infection. Once your ulcer is healed, be wary of your
legs. Try not to bang them against furniture and keep in touch with your
physician, who will probably recommend a moderate exercise program of walking.