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Leg Ulcer Treatment

The below content has been medically reviewed and approved by Consultant Vascular Surgeon Mr. Wissam Al-Jundi (MBBS, FRCS), Deputy Medical Director and member of the Medical Advisory Committee at Veincentre.

Last reviewed 17th October 2021.

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Leg Ulcers

Leg ulcers develop when an area of skin breaks down to reveal the underlying flesh. Venous ulcers are the most common type of leg ulcer, accounting for around 80% of leg ulcers according to NHS statistics. It is estimated that the condition affects as many as 1 in 50 older age adults. They mainly occur just above the ankle and are often very painful.

Leg Ulcers Treatment

At Veincentre, we have almost 20 years’ experience in treating venous leg ulcers via EVLA and foam sclerotherapy. We find that these methods lead to quicker healing and longer-lasting results than traditional approaches (see below). In our experience, leg ulcers tend to remain healed following this treatment pathway.

We were delighted to see the results of the UK-based EVRA trial published in the prestigious New England Journal of Medicine1 , which clearly supports our strategy. (EVRA means “early endovenous ablation”.)

As the article itself states, this trial was the first to demonstrate that “early endovenous ablation of superficial venous reflux resulted in faster healing of venous leg ulcers and more time free from ulcers than deferred endovenous ablation”.

This followed an earlier study2 that had shown that traditional surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer-free time.

Although this earlier study had shown that surgical correction of venous insufficiency reduced recurrence, the fact that it also showed no improvement in ulcer healing held back the most effective treatment of venous leg ulcers by many years.

Our Approach Vs. the Traditional Approach

The NHS continues to treat leg ulcers with a process of cleaning and dressing the affected area, committing the patient to a lengthy period in compression bandages to theoretically help improve circulation and to treat swelling.

This process is usually undertaken by a district nurse, usually weekly, and is incredibly time-consuming. It has been estimated that treating leg ulcers takes up 50% of district nurses’ time.

Whilst compression therapy is an essential part of leg ulcer management, it needs to be augmented with eliminating any superficial vein reflux after careful assessment by a vascular specialist and early EVLA if required. Access to this type of treatment on the NHS is however not always available in a timely manner due to limited funding for this type of treatment.

Home Remedies

If you believe that you are at risk of developing venous ulcers, you can make changes to your lifestyle to potentially help prevent their onset. Getting regular exercise, eating healthily, and getting enough sleep to feel rested, perhaps to aid losing weight, may help improve blood flow in both arteries and veins. If you are a smoker, quitting will take some of the strain off your cardiovascular system, which in turn can help the circulation.

If you develop leg ulcers, seek medical opinion.  If your ulcers prove to be venous in origin, you will need compression bandages and referral for a venous scan to address any superficial venous reflux.

Once the ulcer heals, you would benefit from wearing compression stockings, as they help reduce leg swelling by helping blood flow back to the heart. Try to keep your legs elevated while sitting, keeping your legs above your heart, to help blood flow out of your leg and prevent pooling. Propping your legs up on a pillow or cushion is perhaps the simplest way to achieve the appropriate elevation.

Leg Ulcer Treatment Aftercare

We would advise you to continue with your simple dressing and wearing the compression stocking provided by Veincentre for a week following EVLA and then to continue with dressings/bandaging provided from your GP surgery following this until the ulcer is fully healed.

Treatment Risks

With all medical treatments it’s important to weigh up the benefits versus the risks. With that in mind, we have provided you with a full outline of the known vein treatment risks.

References

1. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. May 31, 2018
N Engl J Med 2018; 378:2105-2114. DOI: 10.1056/NEJMoa1801214
(https://www.nejm.org/doi/full/10.1056/nejmoa1801214)
2. “Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ. 2007 Jul 14;335(7610):83. doi: 10.1136/bmj.39216.542442.BE. Epub 2007 Jun 1.”
(https://www.bmj.com/content/335/7610/83)

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