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Medical Edge Newspaper Column from Mayo Clinic
A FOUR-STEP APPROACH TO LEG ULCER CARE
Dear Mayo Clinic: I’ve had a stasis ulcer on the calf of my leg for over a year. It drains every day and is very sore. I have been to several doctors and wound-care facilities, and they can’t seem to heal it. What would you recommend that I do? — Phoenix, Ariz.
Answer: I advocate a four-step approach to caring for an ulcer, which basically is an open sore:
Determine the cause of the ulcer. You say in your question that this is a “stasis ulcer,” which implies that it is caused by a vein problem. But is this the correct diagnosis? Many times, the reason why an ulcer won’t heal is that its underlying cause has been misdiagnosed. Other factors that must be considered are the arterial blood supply, infection, pressure over the wound and many other things. Your doctor may need to perform a variety of tests to determine the cause(s) of your ulcer.
Treat the underlying cause. If this is, as you suggest, an ulcer caused by bad veins — wherein inadequate circulation results in the pooling of blood in the leg, thereby starving the overlying skin tissue — you will need to improve that circulation. This usually requires the aggressive use of elastic compression devices such as elastic wraps and compression stockings. In some cases, surgical procedures such as vein stripping (removal of a problem vein, thereby shifting circulation to healthy veins) or the opening of a blocked vein may be useful.
Of course, if your ulcer is caused by other problems (such as infection or arterial blockage) you may need antibiotics, a bypass operation, a balloon angioplasty or other specific treatments.
Create the proper environment for healing. The “proper” environment is established by first removing necrotic (dead) material — a process called debridement — so that the ulcer is clean, and then applying a dressing in order to protect the wound and provide ideal hydration. Most ulcers heal best under moist conditions, although some ulcers produce so much drainage that they become too moist.
Hundreds of different dressing types are available. Suffice it to say that a dressing can be chosen specifically for your ulcer based on drainage, presence of infection, depth of the ulcer and other factors.
Use extraordinary measures only if necessary. More than 90 percent of all ulcers will heal if you diagnose them correctly, treat the underlying cause, and create a clean, moist and healthy environment around them.
Those that do not heal may require “extraordinary measures,” which can include skin grafting (the transfer of healthy skin from elsewhere in the body to cover the wound), hyperbaric oxygen (exposure to pure oxygen under increased pressure in order to aid tissue regrowth), various pneumatic pumps (compression therapy aimed at enhancing blood flow to and from the leg) and many other devices or procedures, depending on the nature of the problem.
— Thom W. Rooke, M.D., F.A.C.C., Vascular Medicine, Mayo Clinic, Rochester, Minn.
Additional Resources:
Vascular Surgery
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Generics make up more than 50 percent of drugs prescribed today. Compared with brand name drugs, generics can cost 30 percent to 80 percent less.
The popularity and availability of generic drugs resulted from the federal Hatch-Waxman Act of 1984. Until then, only about 12 percent of prescription drugs were generics. The act allowed companies that manufactured generic drugs to forgo costly duplication of expensive clinical trials already conducted by the developer of the brand name medication.
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Accupril (generic name quinapril) for high blood pressure and heart failure
Allegra (fexofenadine) for allergy
Amaryl (glimepiride) for diabetes
Cefzil (cefprozil), an antibiotic
Flonase (fluticasone), an allergy nasal steroid spray
Neurontin (gabapentin) for neuropathy
Pravachol (pravastatin) for cholesterol management
Propecia (finasteride) for male hair loss
Proscar (finasteride) for enlarged prostate
Zithromax (azithromycin), an antibiotic
Zocor (simvastatin) for cholesterol management
Zoloft (sertraline) for depression
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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