The word “Ulcer” means a break in the layer of cells forming a surface. This can occur in many different areas of the body. In each area, there are can be distinct issues causing the ulcer to form.
A stomach ulcer for example is caused by the lining of the stomach breaking down, allowing acid to attack the underlying tissue. This is somewhat different to the cause of leg ulcers, although similar principles can be applied. You don’t cure a stomach ulcer, or leg ulcer with creams and bandages!
Rather than acid, air and bacteria cause leg ulcers, when the skin breaks down and allows them to get into the underlying tissue. As an ulcer appears on the leg, it is tempting to put dressings and creams on, hoping the skin will grow back. However, years of research have shown the usual cause of leg ulcers is not the skin, but the underlying blood supply to the skin.
Successful treatment of ulcers and successful prevention of ulcers must be directed at correcting the underlying cause, not the ulcer itself.
Although having a leg ulcer is an obvious condition, often more difficult for people (as well as non-specialist doctors and nurses) to spot those who are heading towards ulceration. An opportunity to prevent the worst symptoms ever appearing can be missed.
With improving information, many people with severe varicose veins are seeking specialist opinions and are quite correctly bypassing doctors who give the old advice of “leave them until they cause a problem”.
Seeking specialist opinion is a good idea, even though many people at risk of ulceration do not have any varicose veins to see. These people have superficial vein valve failure, often inflammation of the skin but the veins have not dilated and so no varicose vein can be seen.
One of the early warning signs is a RED or BROWN PATCH OF SKIN on the lower leg, just above the ankle, usually on the inner side. This is called Lipodermatosclerosis (LDS). Without treatment (or if creams or pressure stockings are given instead of referral to a Vascular Surgeon) this slowly deteriorates to dark brown staining, called Haemosiderin. If left, white patches appear in the skin, where the skin itself is breaking down. These rapidly go on to complete breakdown and ulceration.
At any stage in this deterioration, a referral to a specialist vascular surgeon is likely to result in definitive treatment that not only stops further deterioration but often reverses the whole process.
One note of CAUTION – The patient MUST BE ABLE TO USE THE LEG PUMP – If the patient is unable to walk or has poor ankle movement, unfortunately, surgery is unlikely to help. There is little to be achieved by stopping the reflux after pumping, if there is no pumping in the first place.
So in a nutshell, those who need assessment for treatment are: