Chronic lower leg ulcers

L97

DESCRIPTION

A chronic relapsing disorder of the lower limbs.
Associated with vascular insufficiency (predominantly venous insufficiency) and patient immobility.
Commonly associated with neuropathy, infections, neoplasia, trauma or other rare conditions.

GENERAL MEASURES

  • If the ulcer is oedema- or stasis-related, rest the leg in an elevated position.
  • In venous insufficiency, compression (bandages or stockings) are essential to achieve and maintain healing, provided the arterial supply is normal.
  • In patients with arterial insufficiency, avoid pressure on bony prominences and the toes.
  • In patients with neuropathy, relieve pressure from the area.
  • Exclude diabetes with finger prick blood glucose test.
  • Avoid topical application of home remedies.
  • Stress meticulous foot care and avoidance of minor trauma. Encourage patients with neuropathy not to walk barefoot, check their shoes for foreign objects, examine their feet daily for trauma and to test bath water before bathing to prevent getting burnt.
  • Avoid excessive local heat.
  • Walking and exercises are recommended.

MEDICINE TREATMENT

Refer for assessment and initiation of treatment.

Local wound care:

Topical cleansing

Use bland, non-toxic products to clean the ulcer and surrounding skin.

For clean uninfected wounds:

  • Sodium chloride, 0.9% or sterile water.

Dressed frequently with:

  • Moistened dressing e.g. gauze with Sodium chloride, 0.9%.

LoE:I[5]

For exudative, infected wounds:

  • Povidone-iodine 5% cream, topical apply daily

LoE:III[6]

For venous ulcers:

  • Paraffin gauze dressing.

REFERRAL

  • No improvement after 1 month.
  • All foot ulcers.
  • Ulcers with atypical appearance.
  • Venous ulcers that are persistently infected, or have offensive odour.