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Lucinda asked...

Chronic leg ulcer

I have a chronic leg ulcer which is not healing. I am seeing a dermatologist and practice nurse but nothing is helping it heal. I have an autoimmune disease and am 32. I have had my ulcer for a year now. Can you advise me of any treatment to help the healing?

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The answer

As you say that you have an Auto-Immune Disease this will impact not only on your daily life but also in the way your body responds to infections, trauma and injury.

You do not say what the precise nature of the disease is but we suspect imbalance of chemicals/ hormones, the way the body fights infection and inflammation are affected.

It may be that the circulation to your leg is affected by inflammation and poor blood supply to the ulcer and these factors alone can inhibit the healing process.

Medication being taken can also affect healing by altering nutrient levels required to maximise healing.

You say that you are being seen by the Practice Nurse and a Dermatologist but that current therapy is ineffective. I would suggest that you ask your GP to refer you to a wound/Vascular Specialist as they may be able to review current therapy and suggest different techniques and dressings to promote healing.

Dressings for ulcers are always being developed and it might be a good idea to try some newer dressings.

Have you had investigations to check for infection in the wound and diabetes as this should be considered in relation to wound care?

Another new treatment which is becoming publicised more of late is Hyperbaric Oxygen Therapy (HBOT).

HBOT was first used for divers suffering from compression sickness but now further research has been done which shows that it can help with many illnesses and in the treatment of ulcers which are not healing properly.

HBOT works by increasing the amount of oxygen being supplied to the body therefore increasing the amount of oxygen being circulated around the body. Where there are leg ulcers, circulation to the affected parts is reduced and this inhibits healing. HBOT would help healing by increasing the amount of oxygen being supplied to the skin and nerve cells therefore reducing infection, swelling and inflammation. It would also enable the cells to heal, replenish and work more efficiently. HBOT would be needed over a period of time to ensure full healing.

Other ways to help with the healing and prevention of further ulcers is to ensure a healthier lifestyle involving a balanced diet and exercise and ideally stopping smoking if this applies to you.

When resting you should have your legs elevated and rotating your ankles/ do leg ulcers to aid circulation and reduce swelling.

Anti – embolic compression stockings which fit correctly can also help with circulation.

If you are in pain or having itchy and flaky skin analgesics and ointments which are suitable for your use can be prescribed and taken. Always refer to your GP or Pharmacist for advice prior to taking this line of action.

As mentioned before we feel that it would be appropriate to seek further review from specialists who may be able to prescribe new treatment and therapy and who can liaise with your GP about dressings and wound care and involve District and Practice Nurses making life easier for you.

Answered by the Health at Hand nurses

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