Leg ulcers - Assisting a family member

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Assisting a family member

Assisting a family member

Leg ulcers

Classification of ulcers Treatment of leg ulcers: compression therapy Cleansing ulcers How to recognize an infected ulcer The ideal dressing Evaluating pain Prevention of recurrence
  • Classification of ulcers
    • Venous ulcer
    • Arterial ulcer
    • Mixed ulcer
  • Leg ulcer treatment: compression therapy
  • Cleansing of ulcers
  • How to recognize an infected ulcer
  • The ideal dressing
  • Evaluate the pain
  • Relapse prevention

The quality of life of people with ulcers suffers from the complexity of the needs that their condition entails and those who take care of them often encounter considerable difficulties in managing this type of pathology. The home nursing service follows the patients who need it and spends a lot of time in the care of people with lower limb ulcers, but it is not always able to cope with the increase in requests: for this reason it is good to be ready to face the problem or at least emergencies.

About 1% of the adult population suffers from ulcers of the lower limbs (UAI) and the incidence increases with aging: the maximum peak occurs between 70 and 80 years; females are the most affected of the two sexes (3: 1). Many older people suffer from lower limb ulcers (50%) and the main cause is venous insufficiency. In Italy there are many hospitalizations per year, around 30, 000, and healthcare costs amount to around 1500 euros per capita. The impact of ulcers on daily life is enormous, the main limitations are: persistent pain, immobility, sleep disturbances, limitations in work and leisure, lack of self-esteem, worries and frustrations. To these limitations are added: chronic fatigue, as a result of lack of adequate sleep, wound infections and social isolation. As a result, patients with ulcers have a much poorer quality of life than healthy people; the necessary and regular medications also influence the normal activities of daily life. Ulcers are not common wounds: they are in fact defined as chronic because they have little tendency to spontaneous healing and last for more than 8 weeks. The treatment of these lesions must follow a precise pattern and often requires the presence of qualified personnel, although it is possible to train a relative or a volunteer to perform dressings and bandages in some specific situations.

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Classification of ulcers

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Venous ulcer

Usually the most frequent and benign lesions found in the legs are wounds that have a venous cause (etiology). These ulcers are the end product of chronic venous insufficiency (IVC). The hypotheses underlying their onset are manifold and as the only common denominator they have venous hypertension (increased pressure inside the veins), as a consequence of IVC, and edema.

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Arterial ulcer

Arterial ulcers are lesions that affect patients affected by occlusion of the arteries (obliterating arteriopathy) and are not benign at all, that is, they occur as a result of inadequate circulation in medium and small arteries. Sometimes ulcers are caused by the detachment of emboli that occlude the downstream arteries. Arterial ulcers are preceded by redness (erythemato-cyanotic manifestations) in particular locations (metatarsals, fingers). When the stage of the disease is advanced, the reduction of blood flow produces a very intense pain characterized by jolts, pains with a sensation of constriction in the calf, difficulty in making movements (functional impotence) and by a peculiar sign consisting of an increase in suffering if the leg is raised (with the patient lying in the bed): in fact, subjects with arterial insufficiency report feeling less pain while sitting with their feet on the ground. When the limb is raised, the foot tends to turn pale and the normal complexion is restored a few seconds after bringing it back to the declining position (capillary filling test).

Arterial lesions usually occur on the front and outside of the leg and foot and have a peculiar appearance, as they usually occur with a well-attached hard and blackish plaque and well-defined margins.

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Mixed ulcer

Ulcerative lesions that have a mixed component are an expression of the simultaneous association of arterial and venous disease.

There are many other ulcers that will not be listed here since their frequency is quite rare (tropical, autoimmune ulcers, etc.).

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