Clinico-epidemiological study of chronic leg ulcers in a tertiary care referral center from Tamil Nadu, India

Background: Leg ulcer is a common ailment of elderly presented with complex dermatological conditions. It may occur as a sequel to infection, malignancy, adverse drug reaction, trauma and hematological disorders. The paucity of data on the prevalence and outcome of the chronic leg ulcer in India served as a basis to conduct this clinico-epidemiological study. To study the prevalence of leg ulcers in a tertiary care referral hospital.Methods: In this cross-sectional study, 100 patients with leg ulcer attending the dermatology OPD at Madras medical college, Chennai, were enrolled after obtaining their consent. Detailed case history of each patient was recorded. Routine clinical investigations, Doppler study and culture were done to detect associated complications. In this study, 58 males and 42 females, with the mean age of 42.01±14.302 years, mean duration of leg ulcer of 17.79±29.87 months were recruited.Results: Venous ulcer (37%) was the most prevalent type of leg ulcer recorded in our study. Doppler study revealed that the 31% of venous ulcers patients developed perforator incompetence. Staphylococcus aureus was the major microbe isolated from the lesions (27%).Conclusions: Chronic leg ulcers are very common in elderly patients and venous ulcer being the most common. Doppler is an effective tool for the assessment of disease severity of venous ulcers and aided in offering the adequate management of the disease. Diagnosis of underlying causes such as pyoderma gangrenosum, autoimmune diseases, malignancies and bacterial culture from the wound will be helpful for the management of the disease.

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Causes and the way of treatment of patients with chronic leg ulcers

Phlebologie ◽

10.1055/s-0037-1622275 ◽

2009 ◽

Vol 38 (05) ◽

pp. 211-218 ◽

Cited By ~ 2

Author(s):

C. Wax ◽

A. Körber ◽

J. Dissemond ◽

J. Klode

Keyword(s):

Treatment Period ◽

General Practitioners ◽

Peripheral Arterial Occlusive Disease ◽

Mean Value ◽

Arterial Occlusive Disease ◽

Leg Ulcer ◽

Leg Ulcers ◽

Patient Will ◽

Peripheral Arterial ◽

Chronic Leg Ulcers

SummaryChronic leg ulcer may have various causes, which are currently not centrally recorded in Germany. It is also unclear who treats patients with chronic leg ulcers in Germany and how the basic implementation of diagnosis and treatment of these patients looks like. Patients, methods: Therefore, we started a survey of 1000 general practitioners and practising specialists in dermatology, surgery and phlebology in five different regions of Germany. We carried out the genesis of a total of 6275 patients from 62 different practising therapists, 33 specialists in dermatology, surgery or phlebology and 29 general practitioners. Results: In 66.1% of all patients we found a venous leg ulcer, in 9.1% a leg ulcer from peripheral arterial occlusive disease, and in 8.5% a mixture of both. Thus there suffered a total of 83.8% of patients on chronic venous insufficiency or peripheral arterial occlusive disease as a major factor in the genesis of the chronic leg ulcer. However, even the rarely diagnosed entities such as exogenous factors, vasculitis, pyoderma gangrenosum or infectious diseases are occur in summation in 16.2% of all patients and should therefore be known and excluded. In addition, the treatment periods and referral routes of patients with chronic leg ulcer should be identified. The analysis showed that the vast majority (86.8%) of patients with chronic ulcers who were investigated by us is treated by specialists. The treatment duration of general practitioners is 6.3 weeks (mean value) before the patient will be referred to a specialist. This treatment period is significantly shorter compared to the treatment period of the specialists, who treat their patients 14.1 weeks (mean value) before the patient will be referred to another specialist or to a clinic. Conclusion: Our results show the current aspects of aetiology and the way of treatment of patients with chronic leg ulcers in Germany.

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Leg ulcer

Oxford Cases in Medicine and Surgery ◽

10.1093/oso/9780198716228.003.0035 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Diabetes Mellitus ◽

Time Course ◽

Pressure Ulcers ◽

Leg Ulcer ◽

The Other ◽

Venous Stasis ◽

Leg Ulcers ◽

Venous Ulcers ◽

Patients With Diabetes ◽

Neuropathic Ulcers

Venous ulcers account for by far the majority (about 70%), with mixed arterial/venous (about 10%) and arterial (about 10%) most of the remainder. Pressure ulcers have become increasingly common because of the increase in elderly, frail, and relatively immobile patients. The other causes are relatively rare with the exception of neuropathic ulcers in patients with diabetes mellitus. Note that many leg ulcers may have a multifactorial aetiology, i.e. they may involve more than one of the pathologies listed in Figure 29.1. The first thing is to ask about the ulcer. You should consider: • Is the ulcer painful? ■ Venous ulcers are caused by venous stasis in the leg and are thus less painful when elevated and drained of blood. However, only about 30% of venous ulcers are painful. ■ Arterial (atherosclerotic) ulcers are caused by ischaemia to the leg and are thus more painful when elevated and drained of blood. Patients often say the ulcers are painful enough to wake them up at night and that they obtain relief by lowering their leg over the side of the bed. ■ Neuropathic ulcers are caused by loss of sensation (which predisposes to constant trauma) and are thus not painful. ■ Pressure ulcers are caused by, as the name suggests, prolonged pressure on the affected site. They tend to be exquisitely tender but not necessarily painful if no pressure is being applied. • How long has the ulcer been there? ■ Venous ulcers are less painful and can therefore present late. They often have a long and recurring history. ■ Arterial ulcers tend to present relatively early because of pain. They often occur secondary to trivial trauma. ■ Neuropathic ulcers are associated with a loss of sensation and thus often present late. ■ Pressure ulcers can develop surprisingly rapidly (e.g. days in immobile patients if they are not turned regularly during their admission, even hours in patients who suffer a long lie following a fall), but can have a more indolent course depending on how much pressure is put on for how long. Thus the time course is not especially helpful. ■ A long history should arouse suspicion of a Marjolin ulcer, which only occurs in long-standing ulcers.

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Design of Randomized Controlled Trials in the Treatment of Leg Ulcers: More Answers with Fewer Patients

Phlebology The Journal of Venous Disease ◽

10.1177/026835559801300305 ◽

1998 ◽

Vol 13 (3) ◽

pp. 107-112 ◽

Cited By ~ 9

Author(s):

R. J. Prescott ◽

E. A. Nelson ◽

J. J. Dale ◽

D. R. Harper ◽

C. V. Ruckley

Keyword(s):

Randomized Controlled Trials ◽

Factorial Design ◽

Outcome Measure ◽

Complete Healing ◽

Leg Ulcer ◽

Controlled Trials ◽

Leg Ulcers ◽

Randomized Controlled ◽

Venous Ulcers ◽

Single Question

Objective: To illustrate the benefit of the factorial design in randomized controlled trials of leg ulcers. Design: A 2 × 2 × 2 factorial design. Setting: Hospital leg ulcer clinics in Edinburgh and Falkirk. Patients: Adults with at least one unhealed leg ulcer of determined origin, present for at least 2 months and greater than 1 cm in diameter. Interventions: Pentoxifylline (Trental) 400 mg, three times daily, versus placebo Main outcome measure: Complete healing of all ulcers within 24 weeks. Results: Of 525 patients screened, 200 pure venous ulcers were randomized (58.5% healed by 24 weeks), 45 complex venous ulcers were randomized (57.8% healed) and 41 arterial patients were randomized (excluding bandaging comparisons) (19.5% healed). There were no interactions between treatments. Conclusion: The factorial design was feasible to administer and allowed three therapeutic questions to be investigated using the same resources as would have been needed to answer a single question.

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Frequency of Isolated Superficial Venous Incompetence in Patients with Venous Ulcers as Measured by Ambulatory Strain-Gauge Plethysmography

Phlebology The Journal of Venous Disease ◽

10.1177/026835559501000207 ◽

1995 ◽

Vol 10 (2) ◽

pp. 65-68 ◽

Cited By ~ 2

Author(s):

C. Hansson ◽

J. Holm

Keyword(s):

Strain Gauge ◽

Screening Method ◽

Leg Ulcer ◽

Leg Ulcers ◽

Pressure Measurements ◽

Venous Leg Ulcer ◽

Venous Ulceration ◽

Venous Leg Ulcers ◽

Strain Gauge Plethysmography ◽

Venous Ulcers

Objective: Identification of isolated superficial venous incompetence (SVI) in patients with clinically diagnosed venous leg ulcers using a computerized strain-gauge plethysmograph. Design: Ambulatory leg ulcer patients were assessed as to the clinical diagnosis. Diagnoses other than venous ulceration were excluded. Setting: Department of Dermatology, Sahlgrenska Hospital, Göteborg, Sweden. Patients: One hundred and fourteen patients (133 legs) with venous leg ulcers were investigated. Main outcome measures: All patients were also investigated by measuring systolic ankle and arm pressure measurements. The ankle/arm (AI) was below 0.9 in 22 of the 133 ulcerated legs. Results: Of the 111 ulcerated legs with an AI>0.9, 10% had an isolated SVI. Conclusions: Isolated SVI is an important cause of venous leg ulcer development. Strain-gauge plethysmography is an inexpensive screening method, and is easy to use. Further examination with the more exact, but also more expensive and time-consuming, colour duplex should be performed in selected cases.

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CLINICO-ETIOLOGICAL EVALUATION OF CHRONIC LEG ULCER IN DEPARTMENT OF DERMATOLOGY, PATNA MEDICAL COLLEGE AND HOSPITAL, PATNA, BIHAR.

10.36106/ijsr/1229396 ◽

2021 ◽

pp. 62-64

Author(s):

Alok Kumar ◽

Vikas Shankar ◽

Manadavi Manadavi ◽

Ayushi Ayushi ◽

Debarshi Jana

Keyword(s):

Care Center ◽

Tertiary Care ◽

Ankle Brachial Index ◽

Public Health Problem ◽

Arterial Disease ◽

Venous Ulcer ◽

Leg Ulcer ◽

Similar Data ◽

Medical College ◽

Peripheral Arterial

Background:Achronic leg ulcer (CLU) is a signicant public health problem. It has various etiologies. Racial, familial, occupational, and social factors may also have an impact on the prevalence of different causes of leg ulcers. Though there are western data on the epidemiology of leg ulcer, similar data are largely unavailable from our part of the world. Aims:We undertook a study in PMCH, Patna, Bihar, a tertiary care center to determine the clinical and etiological pattern of patients with CLU. Materials And Methods: Hundred consecutive patients presenting with CLU, fullling the criteria, were included after informed consent. Patients were subjected to proper history taking, clinical examination, routine blood test, and pus for culture and sensitivity test (where needed) along with Ankle Brachial Index (ABI). Results: Among the 100 patients, venous ulcer (34%) was predominant followed by arterial ulcer (14%), mixed arterial and venous ulcer (11%). History of smoking (56%) and obesity (BMI >25) (32%) were the common risk factors in leg ulcer patients. Fifty nine percent of the total CLU were infected and out of this, 86.4% showed growth of microorganisms. Staphylococcus aureus (39%) was the most commonly isolated organism, followed by Pseudomonas aeruginosa (15%). Eleven (24.44%) clinically diagnosed venous ulcer patients showed signicantly lower ABI (<0.9) and were diagnosed as mixed ulcer (a venous ulcer with a peripheral arterial disease). Conclusion:Venous ulcer and mixed ulcer are the most common type of CLU

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Seasonal variations in the onset and healing rates of venous leg ulcers

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.008072 ◽

2010 ◽

Vol 25 (1) ◽

pp. 29-34 ◽

Cited By ~ 8

Author(s):

M Simka

Keyword(s):

Time Series ◽

Immune System ◽

Seasonal Variations ◽

Venous Insufficiency ◽

Venous Ulcer ◽

Leg Ulcers ◽

Case Histories ◽

Retrospective Survey ◽

Venous Ulcers ◽

Strong Seasonality

Objectives As many vascular pathologies exhibit circannual fluctuation, the aim of this study was to assess the chronobiological features of venous ulcers. Methods Based on a retrospective survey of the case histories of 391 venous ulcer patients, the rates of ulcer onset and healing in each month were analysed statistically; a time series was constructed to evaluate the seasonality. Results There was a significantly higher frequency of ulcer onset during the warmer part of the year (April–October), and onset showed strong seasonality. Healing rates were also unequally and statistically significantly distributed throughout the year: ulcers that appeared or that were treated with specialized treatment in the winter or summer healed slower in comparison to ulcers that began in the spring or autumn. Conclusions Venous ulcers exhibit circannual fluctuations in their onset and healing rates. Hypothetically, in addition to exacerbation of chronic venous insufficiency, seasonal variations in immune system activity might potentially be responsible for this phenomenon.

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A hospital based cross sectional study on surgical profile of patients with chronic leg ulcers

International Surgery Journal ◽

10.18203/2349-2902.isj20201385 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1153

Author(s):

Archana L. Thakur ◽

Meghraj J. Chawada ◽

P. T. Jamdade

Keyword(s):

Vascular Diseases ◽

Positive Culture ◽

Numerical Data ◽

Detailed Examination ◽

Leg Ulcer ◽

Arterial System ◽

Successful Outcome ◽

Leg Ulcers ◽

Cross Sectional ◽

Chronic Leg Ulcers

Background: Treatment of chronic leg ulcer is not easy. Appropriate diagnosis and proper treatment are the cornerstone for successful outcome. To study the profile of patients with chronic leg ulcers.Methods: Hospital based observational study was carried out in 108 cases. All patients coming to surgery OPD in our set up with chronic leg ulcers of duration of more than 6 weeks were advised admission if they were willing for the same. Then detailed history was recorded. Detailed examination of venous system was done for varicosities, incompetent perforators, sapheno-femoral or poplitio-femoral junction incompetence. In case of patient’s peripheral vascular diseases, detailed examination of arterial system was done. Descriptive statistics like frequencies and percentage for categorical data, mean and SD for numerical data has been depicted.Results: Majority of study subjects were in age range of 60 to 70 years. percentage of male patient (76.9%) was higher than that of the female (23.1%). 43.5% of participants with ulcer on left side and 56.5% participants had ulcer on right side. 47% of participants had complaints between 7 to 8 weeks. main etiological factor was infective etiology in 38.9% patients. 54.1% ulcers were found in lower 1/3rd of the leg. About 88.9% cases had positive culture. The most common organism grown was of pseudomonas in 45.8% cases.Conclusions: The most common etiology of chronic leg ulcer in this study is infective followed by traumatic ulcer. The most common associated condition found in chronic leg ulcer is diabetes mellitus.

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Autologous cultured single-keratinocytes in fibrin glue suspension in chronic venous leg ulcers

Phlebologie ◽

10.1055/s-0037-1617268 ◽

2001 ◽

Vol 30 (02) ◽

pp. 44-47 ◽

Cited By ~ 2

Author(s):

J. Waler ◽

A. Franek ◽

B. Gierat-Kucharzewska ◽

M. Kucharzewski

Keyword(s):

Fibrin Glue ◽

Venous Insufficiency ◽

Leg Ulcer ◽

Ulcer Formation ◽

Leg Ulcers ◽

Venous Leg Ulcer ◽

Venous Leg Ulcers ◽

Rapid Healing ◽

Skin Specimen ◽

Chronic Leg Ulcers

SummaryThe aim of this work was to apply the cultured autologous keratinocytes in fibrin glue suspension in treatment of chronic non-healing venous leg ulcers. 32 patients with chronic leg ulcers caused by venous insufficiency were treated. The surface of ulcers covered 14.2 cm2 to 48.6 cm2. The duration of leg ulcer was between 4 to 20 years. The skin specimen 1.0 × 1.0 cm was taken from the buttock of each patient, from which keratinocytes were obtained. Next those cells were cultured. After 7 days the keratinocytes in fibrin glue were applied to the wound bed. After 2 weeks of treatment the ulceration of 13 patients healed completely whereas the ulcer formation of the rest of the patients diminished by 30%. In all patients the process of healing was successfully completed after further 4 weeks. Our method shows that a rapid healing chronic venous leg ulcer can be achieved by keratinocytes in fibrin glue suspension.

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