Chronic Wound Care

An injury or small wound over the skin will normally heal within a week or two. However, sometimes due to an underlying medical condition, a small wound on the leg may take months to heal and may even increase in size. Such a wound on the leg that takes more than six weeks to heal is called a chronic leg wound. Chronic leg wounds can become infected and threaten the functionality of the patient’s limb and even life.

Most leg wounds are due to an underlying venous disease that usually affects the legs. Though, in some patient’s arterial disease or other conditions such as diabetes and rheumatoid arthritis may also cause poor healing leg wounds. In venous disease, the valves in the legs veins do not function properly or are damaged by clots in the vein. This causes the blood to flow backwards resulting in abnormally high pressure in the vein while standing for a long time. This high pressure damages the skin of the legs and leads to small breaks in the skin that develop into wounds.

The treatment of leg wounds involves regular dressing of the wound to promote healing and use of compression bandaging or stocking to reduce the high pressure in the leg veins. During the dressing changes, the wound is also cleaned by gentle washing in either warm water or saline water. Debridement may be performed under local anaesthetic if there is a large amount of dead tissue over the wound which needs to be removed to promote healing. Compression bandage or stockings are to be worn at all times during the day. Whenever possible the legs should be kept slightly elevated above heart level, putting pillows or cushions under the feet while lying down. .

The dressing and compression bandages are initially changed once every week. The progress in healing is carefully monitored and the type of dressing used is changed depending on the stage of healing. If the wound is infected a course of antibiotics may be prescribed. Pain medication may also be prescribed, if required. Skin grafting may be considered in few rare cases with very large or treatment resistant leg wounds.

Even after the wound heals, there is a chance that the wound may recur as the underlying problem still persists. Thus, the following precautions should be taken to prevent the recurrence of leg wounds:

• Compression bandages and stockings should be used at all times during the day. Legs should be kept elevated, whenever possible.
• Moisturising cream should be applied regularly, to prevent dryness.
• Eating a nutritious diet and exercising regularly is important for general health.
• If you are obese, talk to Mr Limaye about healthy ways to lose weight.
• Quit smoking as it delays healing.

Legs should be regularly examined for any minor skin condition such as blisters, broken skin, swelling or redness and these should be treated at the earliest, to prevent the development of a wound.