An ulcer or leg wound can be caused due to many reasons and can often have more than than one factor as the reason for not healing. The major types of non-healing ulcers can be classified as
A) Arterial ulcers:
An arterial ulcer lacks healing due to inadequate blood supply to a part of the body. It may start as a result of minor injury or with gangrene of the area.
Untreated these ulcers may show further blackish change or gangrene and develop severe pain which would not respond to pain killer medication.
The presence of arterial ulcers shows severe blood flow problems in a limb. Treatment would consist of blood-thinning medication followed by an angiogram to assess the site and extent of blockage in the vessels.
Once defined the blockages can be treated by angioplasty and stenting or bypass surgery to restore blood flow to the limb.
B) Venous ulcer
These ulcers are caused when blood flow from a limb does not return back to the heart. This may happen due to leakage of the blood back into the legs or due to blockage of the blood vessels carrying blood back into the heart.
a) Leakage of veins in the legs results in what is called as varicose veins which shows up in the initial stages as bulging veins in the legs. These are treated by removing or blocking the veins which are leaking. This can be achieved through minimally invasive endovenous ablation (EVLT, RFA) or open surgery.
b) Blockage of the veins can happen due to narrowing of the veins or due to the formation of a blood clot in the veins i.e deep vein thrombosis. These blockages can be opened up by deep venous angioplasty and stenting.
c) Neuropathic ulcers:
Patients with diabetes, renal failure and neve disorders lose sensations of touch, pain, temperature and position over a period of time in the feet. This makes them vulnerable to injury as the foot becomes deformed over time and leads to wounds or ulcer formation.
Such ulcers need to be treated with a combination of wound care and offloading footwear.