LEG ULCERS

Chronic ulcerative skin lesion caused by various aetiologies and often triggered by a minor trauma

Cause/risk factors

  • Vascular, e.g. venous/arterial insufficiency
  • Bacterial: leprosy, Buruli ulcer (by Mycobacterium ulcerans) etc
  • Parasites: guinea worm, leishmaniasis
  • Diabetes, sickle cell disease, malnutrition

Clinical features

  • Often in lower third of the leg
  • Ulcerated lesion with necrotic tissue, slough, discharge, oedema around the lesion, scarring
  • Features of cellulitis due to secondary infection may be present
  • Features of underlying disease

Investigations

  • Swab for C&S
  • X-ray
  • Blood glucose

MANAGEMENT

  • Clean the wound
    • If exudating/dirty lesions: use chlorhexidine solution 0.05% or hydrogen peroxide solution
      6% or povidone iodine 2%
    • If clean wound: use clean water or normal saline
  • Remove necrotic tissue
  • Elevate and rest the leg
  • Perform daily dressing
    • Apply silver sulphadiazine or povidone iodine if the wound is dirty and exudative
    • Otherwise use gauze moistened with normal saline
  • Analgesics for pain if needed

If sign of cellulitis

Prevention

  • Ensure personal hygiene
  • Ensure good nutrition
  • Avoid trauma