Chronic wounds and ulcers

Chronic ulceration often occurs in the setting of disorders of circulation, and adequate healing often requires optimisation of both arterial and venous circulation.

Why do they occur?

There are a number of factors that can lead to chronic ulceration. These include inadequate blood flow to the leg or the foot (or sometimes even the hands) or conversely insufficient venous circulation allowing the blood to flow adequately back towards the heart causing venous erythema, skin changes and sometimes ulceration. There are sometimes less common and rare causes that include skin conditions, other more rare vascular disorders or systemic issues. Even some medications can cause ulcers to develop. Often there is a minor trauma that has occurred damaging the skin, and due to one of these factors the wound is unable to heal and can in some instances deteriorate further.

How is it diagnosed?

A complete history and examination is required often with imaging of both the arteries and veins. Sometimes a tissue biopsy is also required for further examination for more rare and unusual cases.

How is it treated?

First, if there is an underlying circulatory problem this needs to be addressed. This can often mean an angiogram needs to be performed to treat any peripheral vascular disease that may be present. If the problem is with the venous drainage (especially if associated with varicose veins) then ablation of these veins may be needed. This can be done by radiofrequency ablation, venaseal or sclerotherapy.

Other adjunctive measures may be required, which include a good wound dressing plan, compression garments or optimisation of medications or antibiotics.