Leg Ulcers and Lymphedema
Leg ulcers are of major concern in public health because of their high prevalence (especially among older people), chronicity, economic burden, and impact on quality of life. Besides the need for primary prevention in susceptible groups, adequate etiologic diagnosis and a multispecialty approach can lead to successful treatment. Similarly, chronic lymphedema is a limiting disorder that predisposes to recurrent soft skin infection, leg ulcers, and malignancy. In this chapter we discuss clinical patterns, diagnostic procedures, and management of the main types of leg ulcers and lymphedema.
KeywordsLeg ulcer Varicose ulcer Venous insufficiency Lymphedema Martorell’s ulcer Hypertensive ischemic ulcer Lower extremity ulcer
Considered a type of panniculitis (inflammation of subcutaneous fat). Literally means “scarring of the skin and fat” and is a slow process that occurs over a number of years. It is a condition that affects the skin just above the ankle in patients with long-standing venous disease resulting in chronic venous insufficiency. The end result of untreated lipodermosclerosis is ulcer formation with high incidence of delayed healing and infection.
An abnormal collection of high-protein fluid just beneath the skin. It usually develops when lymph vessels are damaged or lymph nodes are removed (secondary lymphedema) but can also be present when lymphatic vessels are missing or impaired due to a hereditary condition (primary lymphedema).
Inflammation of the blood vessels. It causes changes in the walls of blood vessels, including thickening, weakening, narrowing, and scarring. These changes restrict blood flow, resulting in organ and tissue damage.
- 2.Jockenhöfer F, Gollnick H, Herberger K, et al. Aetiology, comorbidities and cofactors of chronic leg ulcers: retrospective evaluation of 1 000 patients from 10 specialised dermatological wound care centers in Germany. Int Wound J. 2016;13(5):821–8.Google Scholar
- 3.Rabe E. Epidemiology of varicose veins. In: Phlebolymphology. 2010;17(1):19.Google Scholar
- 4.Park SH, Ferreira K, Santos VL. Understanding pain and quality of life for patients with chronic venous ulcers. Wounds Compend Clin Res Pract. 2008;20:309–20.Google Scholar
- 13.Vowden P. Understanding the ankle brachial pressure index to treat venous ulceration. Wounds UK. 2012;8:10–5.Google Scholar
- 23.Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy Wound Manag. 2003;49:23–51.Google Scholar
- 24.Nelson EA, Bell-Syer SEM. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2014;(9):CD002303.Google Scholar
- 44.Yesilada AK, Sevim KZ, Sucu DO, et al. Marjolin ulcer: clinical experience with 34 patients over 15 years. J Cutan Med Surg. 2013;17:404–9.Google Scholar
- 47.Clodius L. Lymphatics, lymphodynamics, lymphedema: an update. Plast Surg Outlook. 1990;4:1.Google Scholar
- 50.Pannier F, Hoffmann B, Stang A, Jöckel KH, Rabe E. Prevalence of Stemmer’s sign in the general population. Phlebologie. 2007;36:287–342.Google Scholar