How are leg ulcers cured?
The basic principle of curing a leg ulcer is very simple. It is to find out the underlying cause of the leg ulcer and to correct it. Providing it can be corrected, the body will heal itself as it would do in a normal and healthy person.
Without doubt exercise, physiotherapy, diet (particularly high protein, vitamin C and zinc) will help the healing process.
Ulcer dressings do not heal ulcers unless they have some active growth factor or biological ingredient, but they can make the environment of the ulcer surface more friendly towards healing. However that is useless if the underlying problem hasn’t been corrected.
Compression bandages or compression stockings increase the pressure inside the lower leg that can reduce blood refluxing down “hidden varicose veins” and also reduce swelling of the lower legs. Once again this can help temporary healing but as soon as the compression is removed, the same process starts again and the ulcer recurs. Of course if it is an arterial ulcer, the compression makes the ulcer worse and more painful.
If the ulcer turns out to be incurable by endovenous surgery or arterial surgery, then of course the above factors are all that are available. However as none of these cure leg ulcers but only can hope to “heal” them in the very short term with the virtual certainty that they will come back again, then patients, carers, family as well as doctors and nurses really should be absolutely certain that someone is incurable before sentencing them to a lifetime of dressings and compression bandages.
Curing venous ulcers due to “hidden varicose veins” – the commonest cause of leg ulcers
The majority of venous leg ulcers are due to “hidden varicose veins” (also called superficial venous reflux or chronic venous incompetence). Unfortunately these cannot be seen on the surface and so if a specialised duplex ultrasound scan has not been performed, doctors and nurses may be unaware that “hidden varicose veins” are present.
In these cases, the duplex ultrasound scan shows which of the veins have lost their valves and are allowing blood to fall the wrong way down the “hidden varicose veins”. This backward flow of blood is called “venous reflux” and when it hits the veins at the bottom of the leg, the resulting inflammation causes the skin damage. Over the years, the inflammation and progressive skin damage causes swelling followed by red skin stains, sometimes with venous eczema, followed by brown stains and finally leg ulceration.
Although steroid creams may make any venous eczema feel better, and support stockings and dressings may temporarily reduce the reflux by pushing hard on the outside, none of these factors are a cure.
Once the venous duplex ultrasound scan has identified which veins have lost their valves and are allowing venous reflux, venous specialists can close these “hidden varicose veins” under local anaesthetic using combinations of endovenous laser, radiofrequency ablation, foam sclerotherapy, phlebectomy and perforator vein closure (TRLOP). There are also some new endovenous techniques coming out that might be useful in some patients.
All of these techniques are pinhole procedures and none require a general anaesthetic or sedation. In skilled hands they rarely fail.
Once the venous reflux has been stopped, ulcer healing usually follows within 3 to 6 months provided the patient is walking well and the ulcer isn’t perpetuated by constant dressing. In the majority of people who have had treatment, nature’s own dressing – the scab – is as effective if not more effective than any dressing that is bought from a company.
Compression might be needed if there is still swelling at the ankle or in the short term after foam sclerotherapy but the aim is to try and get the patient out of all compression. There are a proportion of patients who do get a complete cure but due to persistent swelling, often from lymphoedema, will need to wear graduated compression stockings whenever they are up and around. Usually these can be below knee and worn as socks.
Curing venous leg ulcers due to deep vein problems are – a much less common condition
Patients who have either blocked deep veins, reflux in the deep veins or both present a more challenging situation.
However, a large number – if not the majority – of patients who have been told that they have “damaged deep veins” or “blocked deep veins” actually have only “hidden varicose veins” and so are curable. The reason for this is that doctors and nurses traditionally have told anyone who has had a deep vein thrombosis (DVT) in the past that their deep veins will be damaged and that they are incurable.
Research has shown this not to be the case and the majority of patients who have had only one deep vein thrombosis (DVT) which has been treated, end up having normal deep veins. As such there are an awful lot of people in the UK who have been told that they are incurable who are in fact curable.
Therefore do not accept that your ulcer is incurable due to you having deep vein problems unless you have had an expert duplex ultrasound scan that has proven beyond a shadow of a doubt that only your deep veins are causing the ulcer.
If you have had a duplex ultrasound scan and probably another scan to confirm it such as an MRI or venogram, and your deep veins have been shown to be the problem, then there is a lot of research suggesting that you might still be curable.
Although only just coming to the UK, elsewhere in the world and particularly in the United States of America, blocked veins or narrowed veins can be assessed using a specialised investigation called IVUS (intra vascular ultrasound) and the blocked or narrowed veins can be opened up by inserting a expandable metal tube called a “stent”. The results from this have been excellent.
It is one of the aims of this charity to try to raise enough money to increase the research into this sort of cure and make it available to more patients in the UK.
Curing arterial leg ulcers
As noted earlier in this website, arterial ulcers account for approximately one in 10 leg ulcers. The cure for these is to find where the arteries are blocked and to either open up the blockages using balloon angioplasty or arterial stents or even bypass grafts.
Arterial leg ulcers are well catered for in the National Health Service and most vascular surgeons are specialist in arteries not veins. As such although the Leg Ulcer Charity provides information about arterial leg ulcers, particularly empowering patients and carers to try to get a diagnosis, we are not involved in research and treatment of them which is already well supplied in the UK.
Curing other leg ulcers
Leg ulcers due to other conditions are few and far between. It is beyond the scope of this website to go through the rare causes of only a few leg ulcers and the treatments that each specific sort requires.