Ulceration Resulting from Disorders of the Veins and Arteries
Leg ulcers represent a serious burden of disease with an impact, both physical and psychological, that is underestimated. Approximately 50% of all leg ulcers are venous, and another 20% mixed. Venous leg ulcers (VLUs) represent the most advanced grade of chronic venous insufficiency (CVI). CVI results from chronic peripheral venous hypertension. Compression therapy – either using bandages or stockings – is the mainstay in the treatment of CVI and VLUs. Approximately half of patients with VLUs suffer from superficial venous reflux, which can be surgically abolished by a variety of methods. A mixed leg ulcer (MLU) is a VLU in a leg with peripheral arterial disease. MLUs are hard to heal. Management focuses initially on improving arterial inflow, mostly by the use of balloon catheter angioplasty, thereby transforming the MLU into a VLU. As soon as the arterial inflow is restored, management follows the algorithm for VLUs. Arterial leg ulcers result from local skin ischaemia in peripheral arterial disease. Management mainly consists of revascularization and skin grafting. Hypertensive ischaemic leg ulcers represent a form of skin infarction due to occlusive subcutaneous arteriolosclerosis. All patients have hypertension, and 60% have diabetes type 2. From the clinical aspect, these leg ulcers can easily be confused with pyoderma gangrenosum or vasculitic skin necrosis. Treatment consists of necrosectomy, negative pressure wound therapy and, eventually, skin grafting.
Keywords venous leg ulcer, mixed leg ulcer, arterial leg ulcer, hypertensive ischaemic leg ulcer, chronic venous insufficiency, venous reflux, compression therapy, peripheral arterial disease, revascularization, percutaneous transluminal angioplasty, negative pressure wound therapy, skin equivalent, shave operation with skin graft