Ulcer management - Mcglade Vascular Surgery

An ulcer is a break in the skin anywhere on the body but most commonly on the lower legs.

Ulcers are usually broken down into three different types:

Venus and arterial ulcers typically are caused by minor trauma to the skin. In healthy patients these wounds would be expected to heal normally. However, in patients who have in adequate blood supply to the lower legs due to arterial disease or tissue damage due to venous stasis or varicose veins the skin is unable to heal and an ulcer forms.

Patients with diabetes can lose the sensation in their feet, due to nerve damage. Due to lack of sensation, there is a risk that their footwear can cause repetitive trauma to an area of the foot and from this a pressure or neuropathic ulcer will form.

Ulcers can become second early infected as well and this may require treatment with antibiotics.
Ulcers can be caused by a combination of the above factors.

Risk factors for ulcer formation

Smoking
Poorly managed diabetes
High Cholesterol
Poor arterial circulation
Dietary problems
Bed sores from lying in bed for long periods of time
Age

Symptoms

Management

Management of ulcers can be quite complex and they may take a prolonged period to heal. The initial management of any also is to determine its underlying cause and treatment is focused on this. Ulcers always require good dressing management and potentially debridement in order to provide an optimal environment for wound healing. Ulcers often must be managed as part of a multidisciplinary team which may include specialist nurses to aid in dressings as well as podiatrist.

Arterial

Arterial ulcers are a problem of lack of blood supply to the affected area the management is primarily focused on restoring adequate blood supply to the affected area to allow wound healing.

The initial assessment of the ulcer is usually combined with ultrasound and blood pressure testing of the lower leg to ensure enough blood supply for healing. Should the investigations reveal underlying occlusions in the arteries supplying the area with the ulcer that may be a need for revascularisation using either keyhole techniques, with ballooning or stenting or open bypass surgery.

Venous

Penis ulcers are caused by incompetent or varicose veins usually in the lower leg. Over time the stagnant blood flow in the lower leg causes damage to the tissues and the skin usually around the ankle. Due to the damage tissue in the body is unable to heal minor trauma in this area and a small scratch, without specialist involvement, can break out into an ulcer. The main stay of treatment for venous ulcers is good compression therapy on the lower leg aided by radio frequency ablation of incompetent veins.

Neuropathic

These ulcers are caused by a loss of the protective sensation of the foot usually due to diabetes however there are other causes such as significant alcohol consumption or spinal-cord injury. Due to the loss of sensation a patient will not feel repetitive trauma to an area of their foot. This repetitive trauma eventually rubs down the skin and an ulcer forms. The treatment of neuropathic ulcers is primarily with offloading the pressure from the affected area of tissue. This can be done with multiple methods such as special shoes, appropriate dressing, and in some cases casting of the lower leg. Neuropathic ulcers are typically treated with the aid of a podiatrist who is able to remove the pressure from the traumatised area of skin.

Mixed cause ulcers

In the case of an ulcer cause by multiple issues the arterial or blood supply is restored to the leg 1st to enable the application of compression dressings which are used to treat the Venus issues. This can be done concurrently with offloading techniques to treat neuropathic ulcers.

In some cases, patients may require admission to the hospital for intravenous antibiotic treatment and early or aggressive ulcer management. This is usually determined on a case-by-case basis and most alters can be managed in the community with good outpatient care.

Consultation

During your initial consultation with Dr McGlade he will take a thorough history and examination of your ulcer. Depending on the potential underlying cause further investigation, usually in the form of ultrasound and blood pressures of the lower leg, will be ordered.

With the results of the ultrasound doctor will be able to recommend a course of treatment which may require endovascular stenting or bypass of your arteries or radio frequency ablation of varicose veins. Dr McGlade will also implement a dressing care program for your ulcer which may be continued closer to your home or with your local GP.

Dr. McGlade works closely as part of a multidisciplinary team and may recommend other specialist such as the high-risk foot team at the Sunshine Coast University Hospital or one of the local wound care specialists be involved in managing your ulcer. Dr. McGlade will remain the primary carer for your ulcer but will work closely with these other specialists to provide the best outcome for you.

Treatments

Meet Our Doctor

Dr Daniel McGlade

Endovascular & Vascular Surgeon
MBBS, FRACS (Vasc)