LEG ULCERS

Hüray Hügül1 Ayşe Akman2 Mithat Kandemir3

1Antalya Bilim University, Vocational School of Health Services, Antalya, Türkiye
2Akdeniz University, Faculty of Medicine, Department of Dermatology, Antalya, Türkiye
3İstanbul Bilim University, Faculty of Medicine, İstanbul, Türkiye

Hügül H, Akman A, Kandemir M. Leg Ulcers. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.37-45.

ABSTRACT

Leg ulcers, which often arise secondary to venous reflux or obstruction, are a common issue with an estimated prevalence of 1% to 2% in adults. Leg ulcers can arise from numerous underlying conditions such as venous insufficiency, arterial insufficiency, diabetes and pressure injuries. Notably, venous leg ulcers constitute the majority, representing about 70% of all instances. Leg ulcers not only pose a physical burden but also have profound psychological and social implications. The chronic pain, risk of infection and prolonged treatment required often lead to reduced mobility, social isolation and a decreased ability to perform daily activities. Understanding the pathophysiology, risk factors and effective treatment strategies for leg ulcers is crucial for improving patient outcomes and reducing the overall burden on healthcare resources. This section assesses the etiology, clinical manifestations, diagnostic strategies and latest advancements in the treatment of leg ulcers.

Keywords: Leg ulcer; Arterial ulcers; Dermatology; Venous deficiency

Referanslar

  1. Norman G, Westby MJ, Rithalia AD, Stubbs N, Soares MO, Dumville JC. Dressings and topical agents for treating venous leg ulcers. Cochrane Database Syst Rev. 2018;6:CD012583. [Crossref]  [PubMed]
  2. Nelson EA, Adderley U. Venous leg ulcers. BMJ Clin Evid. 2016;2016:1902. Published 2016 Jan 15. [PubMed]
  3. Probst S, Weller CD, Bobbink P, et al. Prevalence and incidence of venous leg ulcers-a protocol for a systematic review. Syst Rev. 2021;10(1):148. Published 2021 May 12. [Crossref]  [PubMed]  [PMC]
  4. Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers. 2013;1:413604. [Crossref]
  5. Casey G. Causes and management of leg and foot ulcers. Nurs Stand. 2004;18(45). [Crossref]  [PubMed]
  6. Akkus G, Sert M. Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities. World J Diabetes. 2022;13(12):1106-1121. [Crossref]  [PubMed]  [PMC]
  7. Akkus G, Sert M. Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities. World J Diabetes. 2022;13(12):1106-1121. [Crossref]  [PubMed]  [PMC]
  8. Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle). 2015;4(9):560-582. [Crossref]  [PubMed]  [PMC]
  9. Chi YW, Raffetto JD. Venous leg ulceration pathophysiology and evidence based treatment. Vasc Med. 2015;20(2):168-181. [Crossref]  [PubMed]
  10. Raffetto JD, Ligi D, Maniscalco R, Khalil RA, Mannello F. Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. J Clin Med. 2020;10(1):29. Published 2020 Dec 24. [Crossref]  [PubMed]  [PMC]
  11. Weir GR, Smart H, van Marle J, Cronje FJ. Arterial disease ulcers, part 1: clinical diagnosis and investigation. Adv Skin Wound Care. 2014;27(9):421-430. [Crossref]  [PubMed]
  12. Karnasula VM. Management of ulcers in lymphoedematous limbs. Indian J Plast Surg. 2012;45(2):261-265. [Crossref]  [PubMed]  [PMC]
  13. Papi M, Papi C. Vasculitic Ulcers. Int J Low Extrem Wounds. 2016;15(1):6-16. [Crossref]  [PubMed]
  14. Janowska A, Dini V, Oranges T, Iannone M, Loggini B, Romanelli M. Atypical Ulcers: Diagnosis and Management. Clin Interv Aging. 2019;14:2137-2143. Published 2019 Dec 10. [Crossref]  [PubMed]  [PMC]
  15. Deinsberger J, Moschitz I, Marquart E, et al. Development of a localization-based algorithm for the prediction of leg ulcer etiology. J Dtsch Dermatol Ges. 2023;21(11):1339-1349. [Crossref]  [PubMed]
  16. GGrey JE, Harding KG, Enoch S. Venous and arterial leg ulcers. BMJ. 2006;332(7537):347-350. [Crossref]  [PubMed]  [PMC]
  17. Alavi A, Sibbald RG, Phillips TJ, et al. What's new: Management of venous leg ulcers: Treating venous leg ulcers. J Am Acad Dermatol. 2016;74(4):643-666. [Crossref]  [PubMed]
  18. O'Donnell TF Jr, Passman MA, Marston WA, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg. 2014;60(2 Suppl):3S-59S. [Crossref]  [PubMed]
  19. Pannier F, Rabe E. Differential diagnosis of leg ulcers. Phlebology. 2013;28 Suppl 1:55-60. [Crossref]  [PubMed]
  20. Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards [published correction appears in J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):288.doi: 10.1016/j.jvsv.2020.11.002.]. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342-352. [Crossref]  [PubMed]
  21. Nowak M, Mehrholz D, Barańska-Rybak W, Nowicki RJ. Wound debridement products and techniques: clinical examples and literature review. Postepy Dermatol Alergol. 2022;39(3):479-490. [Crossref]  [PubMed]  [PMC]
  22. Thomas DC, Tsu CL, Nain RA, Arsat N, Fun SS, Sahid Nik Lah NA. The role of debridement in wound bed preparation in chronic wound: A narrative review. Ann Med Surg (Lond). 2021;71:102876. Published 2021 Oct 4. [Crossref]  [PubMed]  [PMC]
  23. Nuutila K, Eriksson E. Moist Wound Healing with Commonly Available Dressings. Adv Wound Care (New Rochelle). 2021;10(12):685-698. [Crossref]  [PubMed]  [PMC]
  24. Nair B. Compression therapy for venous leg ulcers. Indian Dermatol Online J. 2014;5(3):378-382. [Crossref]  [PubMed]  [PMC]
  25. Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev. 2012;12(12):CD001733. Published 2012 Dec 12. [Crossref]  [PubMed]  [PMC]
  26. Sarma N. Guidelines and recommendation on surgery for venous incompetence and leg ulcer. Indian Dermatol Online J. 2014;5(3):390-395. [Crossref]  [PubMed]  [PMC]
  27. Wang SH, Shyu VB, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel). 2023;13(15):2494. Published 2023 Jul 27. [Crossref]  [PubMed]  [PMC]
  28. Yang L, Rong GC, Wu QN. Diabetic foot ulcer: Challenges and future. World J Diabetes. 2022;13(12):1014-1034. [Crossref]  [PubMed]  [PMC]
  29. Shankaran V, Brooks M, Mostow E. Advanced therapies for chronic wounds: NPWT, engineered skin, growth factors, extracellular matrices. Dermatol Ther. 2013;26(3):215-221. [Crossref]  [PubMed]
  30. Kirby J. Hyperbaric Oxygen Therapy and Negative Pressure as Advanced Wound Management. Mo Med. 2019;116(3):192-194. [PMC]
  31. Vecin NM, Kirsner RS. Skin substitutes as treatment for chronic wounds: current and future directions. Front Med (Lausanne). 2023;10:1154567. Published 2023 Aug 29. [Crossref]  [PubMed]  [PMC]
  32. Situm M, Kolic M, Spoljar S. Quality of Life and Psychological Aspects in Patients with Chronic Leg Ulcer. Acta Med Croatica 2016;70:61-63. [PubMed]
  33. McDaniel JC, Browning KK. Smoking, chronic wound healing, and implications for evidence-based practice. J Wound Ostomy Continence Nurs. 2014;41(5):415-E2. [Crossref]  [PubMed]  [PMC]
  34. Li T, Li Z, Huang L, et al. Cigarette Smoking and Peripheral Vascular Disease are Associated with Increasing Risk of ESKAPE Pathogen Infection in Diabetic Foot Ulcers. Diabetes Metab Syndr Obes. 2022;15:3271-3283. Published 2022 Oct 26. [Crossref]  [PubMed]  [PMC]
  35. Barchitta M, Maugeri A, Favara G, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci. 2019;20(5):1119. Published 2019 Mar 5. [Crossref]  [PubMed]  [PMC]
  36. Roaldsen KS, Biguet G, Elfving B. Physical activity in patients with venous leg ulcer--between engagement and avoidance. A patient perspective. Clin Rehabil. 2011;25(3):275-286. [Crossref]  [PubMed]  [PMC]