A comprehensive study of clinical features and management of ulcers of the lower limb
DOI:
https://doi.org/10.18203/2349-2902.isj20195117Keywords:
Lower limb ulcer, Leg ulcer, Chronic ulcer, Ulcer treatmentAbstract
Background: Leg ulcers are debilitating and painful, greatly reducing patient’s quality of life. These ulcers are often difficult to treat and the successful treatment of leg ulcers depends upon the accurate diagnosis and treatment of the underlying cause.
Methods: This prospective cross sectional study was conducted by Department of General Surgery at College of Medicine and JNM Hospital, Nadia. The study was conducted during the period from September 2017 to August 2019 which included 193 patients presenting with ulcers of the lower limb and admitted in surgical wards of our hospital.
Results: Most of the patients were engaged in agriculture (23.8%) followed by business (22.8%) and service (14.5%). 52.03% of the patients had habit of smoking, chewing tobacco and drinking of alcohol. Most of the ulcers were diabetic (36.3%) followed by venous (22.3%) (Z=2.17; p=0). Only 4.7% and 3.1% were malignant and trophic ulcers. Peripheral neuropathy (23.3%) was the most common type of ulcer followed by venous hypertension (22.3%). At the end of study period, 180 ulcers were healed, 3 had recurrence, 5 were disease free and 5 patients died.
Conclusions: Thus, the study of various cases of leg ulcers arouses lot of interest and is mind boggling as far as the treatment of these cases are concerned. With the availability of arsenal of investigation wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of chronic leg ulcers.
References
Kahle B, Hermanns HJ, Gallenkemper G. Evidence-based treatment of chronic leg ulcers. Deutsches Arzteblatt Int. 2011;108(14):231-7.
Van Gent WB, Wilschut ED, Wittens C. Management of venous ulcer disease. Br Med J. 2010;341(7782):1092-6.
Gonzalez Consuegra RV, Verdu J. Quality of life in people with venous leg ulcers:An integrative review. J Adv Nursing. 2011;67(5):926-44.
Sasanka CS. Venous ulcers of the lower limb:where do we stand? Indian J Plastic Surg. 2012;45(2):266-74.
Amir O, Liu A, Chang ALS. Stratification of highest risk patients with chronic skin ulcers in a Stanford retrospective cohort includes diabetes, need for systemic antibiotics and albumin levels. Ulcers. 2012;31(12):90-8.
Rayner R, Carville K, Keaton J, Prentice J, Santamaria XN. Leg ulcers:Atypical presentations and associated co-morbidities. Wound Pract Res. 2009;17(4):168-85.
Mekkes JR, Loots MAM, Van der Wal AC, Bos JD. Causes, investigation and treatment of leg ulceration. Br J Dermatol. 2003;148(3):388-401.
Faria E, Blanes L, Hochman B, Filho MM, Ferreira L. Health related quality of life, self-esteem, and functional status of patients with leg ulcers. Wounds. 2011;23(1):4-10.
Sen CK, Gardillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, et al. Human skin wounds: A major and snowballing threat to public health and economy. Wound Repair Regeneration. 2009;17(6):763-71.
10.Venugopal TS, Gupta SR, Deepanjali N. A clinicoepidemiological study of non-healing wounds in Rural India. Ind J Surg. 1998;3:22-31.
Cornwall JV, Dore CJ, Lewis JD. Leg Ulcers: Epidemiology and aetiology. Br J Surg. 1986;73:693-6.
Callam MJ, Harper DR, Dale JJ, Ruckley CV. Chronic ulcer of leg:clinical history. BMJ. 1987;294:1389-91.
Saraf SK, Shukla VK, Kaur P, Pandey SS. A clinicoepidemiological profile of non- healing wounds in an Indian hospital. J Wound Care. 2000;9:247-50.
Ghassemi H. Assessment of etiological factors in chronic leg ulcers in Indian population. IJRCD. 2016;2(1):89-93.
Fu X. Skin ulcers in lower extremities: The epidemiology and management in China. Int J of Lower Ext Wounds. 2005;4(1):4-6.
Morton G, Garret M, Reid J, Wingrad D. Current Smoking and Type 2 Diabetes among Patients in Selected Indian Health Service Clinics. 1998-2003. Am J Public Health. 2008;98:560-5.
Jone SK, Tripleff RG. The relationship of cigarette smoking to impaired intra-oral wound healing:A review evidence and implication for patient care. J Oral Maxillo Surg. 1992;50:237-40.
Nagachinta T, Stephens M, Reitz B, Polk BF. Risk factors for surgical wound infection. Muisory cardiac surgery. S Inf Dis. 1987;156:967-73.
Adigun IA, Rahman GA, Fadeyi A. Chronic leg ulcer in the older age group: Etiology and management. Res J Med Sci. 2010. 4(3):107-110.
Korber A, Klode J, Al Benna S, Wax C, Schadendorf D, Steinstraesser L et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Dtsch Dermatol Ges. 2011;9(2):116-21.
WHO Report on the Global Tobacco Epidemic, 2008:The MPOWER package. Geneva, World Health Organization, 2008.
Gupta PC, Asma S. Bidi Smoking and Public Health, New Delhi: Ministry of Health and Family Welfare, Government of India. 2008: 145.
Arkkila PE. Thromboangitis obliterans (Buerger's disease). Orphanet J Rare Dis. 2006;1:14.
Malhotra SL. An epidemiological study of varicose veins in Indian railroad workers from south and north of India, with reference to the causation and prevention of varicose veins. Int J Epid. 1972;1:177-83.
Pradeepa R, Rema M, Vignesh J, Deepa M, Deepa R, Mohan V. Prevalence and risk factors for diabetic neuropathy in an urban south Indian population:The Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med. 2008;25:407-12.
Mathangi T, Prabhakaran P. Prevalence of Bacteria Isolated from Type 2 Diabetic Foot Ulcers and the Antibiotic Susceptibility Pattern. Int J Curr Microbiol App Sci. 2013;2(10):21-5.
