Healing of Leg Ulcers



An ulcer is defined as a break in the epithelial continuity. Most common chronic wounds in developed countries are leg ulcers [1]. All tissues in the body are capable of healing by one of two mechanisms: regeneration or repair. Regeneration is the perfect restoration of the preexisting tissue architecture in the absence of scar formation. It is replacement of damaged tissues by identical cells and is more limited than repair. In humans, complete regeneration occurs in a limited tissue compartments like bone and liver. The main healing mechanism is repair where damaged tissue is replaced by connective tissue which then forms a scar. Ulcer healing involves physiological changes by which the body replaces and restores function to damaged part.The healing process passes through different stages which are overlapping with each other. A brief haemostatic phase is followed by inflammatory phase which leads to fibroblastic activity with production of collagen and ground substance and new blood vessels.Finally epithelial cells migrate from the wound edges and reepithelisation takes place. This process of healing is influenced by a number of factors which may accelerate or delay the process of healing.


Granulation Tissue Ulcer Healing Fibroblastic Activity Inflammatory Phase Chronic Ulcer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Williams NS, Bulstrode CJK, O’Connell PR. Wound tissue repair and scars: in bailey and love’s short practice of surgery. 26th ed. CRC Press, Taylor and Francis Group, LLC 6000 Broken Sound Parkway NW, Suite 300 Boca Raton. FL33487–2742; 2013. p. 24.Google Scholar
  2. 2.
    Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL, editors. Textbook of dermatology. 4th ed. Blackwell: Scientific Publications; 2001.Google Scholar
  3. 3.
    Nguyen DT, Orgill DP, Murphy GF. Chapter 4: The pathophysiologic basis for wound healing and cutaneous regeneration. In: Biomaterials for treating skin loss. Cambridge/Boca Raton: Woodhead Publishing (UK/Europe) & CRC Press (US); 2009. p. 25–57. (ISBN 978-1-4200-9989-8/ISBN 978-1-84569-363-3).Google Scholar
  4. 4.
    Stadelmann WK, Digenis AG, Tobin GR. Physiology and healing dynamics of chronic cutaneous wounds. Am J Surg. 1998;176(2A Suppl):26S–38. doi: 10.1016/S0002-9610(98)00183-4.CrossRefPubMedGoogle Scholar
  5. 5.
    De la Torre J, Sholar A. Wound healing: chronic wounds. Emedicine.com. 2006. Accessed 20 Jan 2008.Google Scholar
  6. 6.
    Martin P, Leibovich SJ. Inflammatory cells during wound repair: the good, the bad and the ugly. Trends Cell Biol. 2005;15(11):599–607. doi: 10.1016/j.tcb.2005.09.002.CrossRefPubMedGoogle Scholar
  7. 7.
    Expert Reviews in Molecular Medicine. The phases of cutaneous wound healing. 5:1. Cambridge University Press; 2003. Accessed 20 Jan 2008.Google Scholar
  8. 8.
    Deodhar AK, Rana RE. Surgical physiology of wound healing: a review. J Postgrad Med. 1997;43(2):52–6.PubMedGoogle Scholar
  9. 9.
    Ovchinnikov, Dmitry A. Macrophages in the embryo and beyond: much more than just giant phagocytes. Institute for Molecular Bioscience and Cooperative Research Centre for Chronic Inflammatory Diseases (CRC-CID), University of Queensland, Brisbane, Queensland, Australia: researchgate.net. 2008 doi: 10.1002/dvg.20417.
  10. 10.
    Newton PM, Watson JA, Wolowacz RG, Wood EJ. Macrophages restrain contraction of an in vitro wound healing model. Inflammation. 2004;28(4):207–14.CrossRefPubMedGoogle Scholar
  11. 11.
    Mercandetti M, Cohen AJ. Wound healing: healing and repair. Emedicine.com. 2005. Accessed 20 Jan 2008.Google Scholar
  12. 12.
    Stashak TS, Farstvedt E, Othic A. Update on wound dressings: indications and best use. Clin Tech Equine Pract. 2004;3(2):148–63. doi: 10.1053/j.ctep.2004.08.006.CrossRefGoogle Scholar
  13. 13.
    Midwood KS, Williams LV, Schwarzbauer JE. Tissue repair and the dynamics of the extracellular matrix. Int J Biochem Cell Biol. 2004;36(6):1031–7. doi: 10.1016/j.biocel.2003.12.003.CrossRefPubMedGoogle Scholar
  14. 14.
    Falanga V. Wound healing and its impairment in the diabetic foot. Lancet 2005;366:1736–43.Google Scholar
  15. 15.
    Kuwahara RT, Rasberry R. Chemical peels. Emedicine.com. Accessed 15 Sept 2007.Google Scholar
  16. 16.
    Romo T, Pearson JM. Wound healing, skin. Emedicine.com. 2005. Accessed 27 Dec 2006.Google Scholar
  17. 17.
    Greenhalgh DG. The role of apoptosis in wound healing. Int J Biochem Cell Biol. 1998;30(9):1019–30. doi: 10.1016/S1357-2725(98)00058-2.CrossRefPubMedGoogle Scholar
  18. 18.
    Song G, Nguyen DT, Pietramaggiori G, Scherer S, Chen B, Zhan Q, Ogawa R, Yannas IV, et al. Use of the parabiotic model in studies of cutaneous wound healing to define the participation of circulating cells. Wound Repair Regen. 2010;18(4):426–32. doi: 10.1111/j.1524-475X.2010.00595.x. PMC 2935287.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rosenberg L, de la Torre J. Wound healing, growth factors. Emedicine.com. 2006. Accessed 20 Jan 2008.Google Scholar
  20. 20.
    Pollock RE, Brunicardi FC, Andersen DK, Billiar TR, David D, Hunter JG, Matthews JJ. The cellular, biochemical, and mechanical phases of wound healing. In: Schwartz’s principles of surgery. 9th ed. McGraw-Hill Professional. ISBN 0-07-154769-X.2009.Google Scholar
  21. 21.
    DiPietro LA, Burns AL. Wound healing: methods and protocols. In: Methods in molecular medicine. Totowa, N.J.: Humana Press. Electronic book; 2003.Google Scholar
  22. 22.
    Fu XB, Sun TZ, Li XK, Sheng ZY. Morphological and distribution characteristics of sweat glands in hypertrophic scar and their possible effects on sweat gland regeneration. Chin Med J (Engl). 2005;118(3):186–91.Google Scholar
  23. 23.
    “BURN INJURIES”. National trauma institute.org. Retrieved 18-03-08.Google Scholar
  24. 24.
    Lorenz HP, Longaker MT. Wounds: biology, pathology, and management. Stanford University Medical Center. 2003. Accessed 20 Jan 2008.Google Scholar
  25. 25.
    Larjava H, Koivisto L, Hakkinen L. Chapter 3: Keratinocyte interactions with fibronectin during wound healing. In: Heino J, Kahari VM, editors. Cell invasion, Medical intelligence unit, vol. 33. Georgetown, Tex., Austin: Tex Landes Bioscience, Inc. Electronic book; 2002.Google Scholar
  26. 26.
    Santoro MM, Gaudino G. Cellular and molecular facets of keratinocyte reepithelization during wound healing. Exp Cell Res. 2005;304(1):274–86. doi: 10.1016/j.yexcr.2004.10.033.CrossRefPubMedGoogle Scholar
  27. 27.
    Hinz B. Masters and servants of the force: the role of matrix adhesions in myofibroblast force perception and transmission. Eur J Cell Biol. 2006;85(3–4):175–81. doi: 10.1016/j.ejcb.2005.09.004.CrossRefPubMedGoogle Scholar
  28. 28.
    Eichler MJ, Carlson MA. Modeling dermal granulation tissue with the linear fibroblast-populated collagen matrix: a comparison with the round matrix model. J Dermatol Sci. 2006;41(2):97–108. doi: 10.1016/j.jdermsci.2005.09.002.CrossRefPubMedGoogle Scholar
  29. 29.
    O’Leary R, Wood EJ, Guillou PJ. Pathological scarring: strategic interventions. Eur J Surg. 2002;168(10):523–34.PubMedGoogle Scholar
  30. 30.
    Desmoulière A, Chaponnier C, Gabbiani G. Tissue repair, contraction, and the myofibroblast. Wound Repair Regen. 2005;13(1):7–12. doi: 10.1111/j.1067-1927.2005.130102.x.CrossRefPubMedGoogle Scholar
  31. 31.
    Argenta LC, Morykwas ML. Vacuum-assisted closure: a new method of wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563–77.CrossRefPubMedGoogle Scholar
  32. 32.
    Nelson EA, Cullum N, Jones J. Venous leg ulcers. Clin Evid. 2006;15:2607–26.Google Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Senior Professor Department of SurgeryPt B D Sharma Post Graduate Institute of Medical SciencesRohtakIndia

Personalised recommendations