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Leg Ulcers are open, non-healing wounds of the legs, usually the lower legs or the feet.
Ulcers can be painful or not painful, big or small, wet or dry, smelly or not smelly. There are many different appearances of ulcers when looked at on the surface and this has resulted in a lot of confusion especially in nurses and dermatologists who only look at the surface.
By looking at the ulcer, you can check that there is nothing abnormal, for example a rare skin cancer growing in it, but there is very little that can be found just from looking at the surface of a leg ulcer. Unquestionably, it is impossible to tell which are curable or incurable just from looking at the surface alone.
The word ‘ulcer’ means a break in the layer of cells forming a surface. This can occur in many different areas of the body, with distinct issues causing the ulcer to form. For example, a stomach ulcer is caused by the cells, forming the lining of the stomach, breaking down and allowing digestive acid to attack the underlying tissue and generate ulcers.
In the case of Leg Ulcers, when the skin cells break down this allows air and bacteria to get into the tissue below. When an ulcer appears on the leg, it’s tempting to apply dressings and creams, hoping the skin will grow back.
However, years of research have shown that the real root cause of the leg ulcer appearing is actually the underlying blood supply to the skin. That’s why, following The Whiteley Protocol®, we insist that successful treatment of ulcers (and the successful prevention of ulcers) must be directed at correcting problems with the underlying blood supply, and not in fact the ulcer itself.
Leg ulcers can be put into 3 main categories:
Venous leg ulcers are the most common and are also the easiest to cure. However, please note that Specialist Vascular Surgeons, like the surgeons at The Whiteley Clinic, always check for other causes as well as arterial causes before treating Venous Leg Ulcers.
This is essential as many leg ulcers occur in older people and they may have more than one cause for their leg ulcers.
Until the 1980s, most doctors and nurses had a clear – but as it turned out, incorrect – understanding of what valve failure meant. They thought failure of the deep valves caused inflammation in the deep tissues, which then resulted in ulcers. As this deep vein reflux could not (and still cannot) be cured surgically, the patient was advised to have regular dressings and tight bandages, to reduce the back flow of blood falling down the deep veins.
It was also believed that failure of superficial valves merely led to stretching of the vein walls and, ultimately, to varicose veins. Equally important, at this time varicose veins were thought to be nothing more than a cosmetic problem that was likely to reoccur, even if treated. NHS patients were therefore told that unless the varicose veins were painful, there was little point in having them surgically removed.
In the late 1980’s, a new test called Duplex Ultrasound showed the medical world the previous thinking on veins had been wrong. Researchers were able to look into veins as they worked, letting us see for the first time what was really taking place. The results of this research were startling:
• around 40% of venous ulcers were found to be due to deep vein valve failure, whereas…
• around 60% of venous ulcers were found to be due to superficial vein valve failure, a condition which was eminently treatable
Developments since have been equally valuable. Although we still have no easy way of treating deep valve failure, superficial valve failure can be successfully treated by specialist surgeons, using new techniques developed for varicose vein surgery in centres such as The Whiteley Clinic.
Even where complicating factors are part of the cause of Leg Ulcers – such as perforated veins – modern techniques can now provide an answer, including techniques such as SEPS (Subfascial Endoscopic Perforator) or its successor, TRLOP (TRansLuminal Occlusion of Perforators). TRLOP is a minimally invasive pin-hole surgery technique performed under local anaesthetic and under ultrasound guidance which was invented by our founder, Professor Whiteley and first presented to the medical community in Rome, in September 2001.
These approaches are now highly developed and, for our surgeons, form part of our routine procedures for patients in the superficial vein valve failure group.