Wounds of The Lower Leg, Venous Skin Ulcers
A skin ulcer is a type of wound that develops on the skin. Several types of several types of ulcers will be mentioned in this article, such as venous skin ulcers, arterial skin ulcers, and neuropathic skin ulcers. There are other ulcers caused by skin cancer and other diseases, but for this topic, we will concentrate on these three, which are the most common.
A venous skin ulcer is a shallow wound that occurs when the leg veins do not return blood back toward the heart the way that they should. This is called venous insufficiency or reflux. The ulcers usually form on the sides of the lower leg, above the ankle and below the calf. These ulcers are slow to heal and often come back if you do not take steps to prevent them. Skin ulcers of the lower leg are also called stasis leg ulcers, chronic indurated cellulitis, which is another term used. Venous ulcers are caused by venous insufficiency of the veins. Your veins have one-way valves that keep blood following the heart. In venous insufficiency, the valves are damaged, and blood backs up and pools in the veins. Fluid may leak out of the veins into the surrounding tissue. This can lead to a breakdown of the tissue and an ulcer.
Another type of ulcer is an arterial skin ulcer. Arterial disease of the arterial system is called PAD, peripheral arterial disease; that is, when the disease is of narrowing, stenosis, or blockage of the arteries it is called peripheral arterial disease or PAD. These are less common than venous ulcers. They happen when the artery becomes blocked or narrowed. These ulcers tend to be extremely painful and are usually on the toes and feet. Neuropathic skin ulcers are also known as diabetic neuropathic ulcers. These ulcers occur in people who have little or no sensation in their feet, ankles, and lower legs due to nerve damage. Many times the first symptoms of skin ulcers are discoloration of the skin, darkening color, sometimes purple, red. The skin also becomes thick, dry, and itchy. Without treatment, these wounds may become infected. The infection may cause odor and drainage. When you first see the signs of an ulcer, you should call the doctor and get to be seen as soon as possible.
At the Jersey Shore Foot and Leg Center, we have been treating vascular disease for over 25 years. We have in-office testing for venous ulcers. We perform Doppler studies. We use a duplex Doppler and color imaging to test how well the blood is moving through the lower leg. We also perform ankle-arm index to evaluate the arterial system. Treatment for the ulcers depends on the cause of the ulcer. With venous ulcers, an accurate diagnosis is important to rule out reflux, after which time initial treatment would be compressive stockings or multilayer compressive bandages, and these are done at the Jersey Shore Foot and Leg Center routinely, after which time other treatment options, including vein ablation using a laser or an RF heat source, also sclerotherapy where we inject the veins with an agent to shrink the vein or actually ambulatory phlebectomy where we remove the small pieces of vein. All of this can be done in the comfortable office setting at Jersey Shore Foot and Leg Center. Arterial ulcers are diagnosed using a bidirectional Doppler, which is a special Doppler to listen to the sound of the arterial flow, after which time advanced testing may be necessary. Advanced testing would consist of either a CTA, which is a CAT scan of the arteries, or an MRA, which is an MR of the arterial system. After this, the decision would be made with regard to the advanced follow-up treatment, which consists of wound angioplasty, stenting, or open surgical procedures. Again, these could be discussed on an individual basis with the doctors at the Jersey Shore Foot and Leg Center.
In conclusion, wounds presenting on the lower extremity could be caused by arterial blood flow problems, venous blood flow problems or the patient may have adequate blood flow and the ulcer could be caused by a loss of feeling, which is a neuropathy. Physicians at the Jersey Shore Foot and Leg Center have been treating people with these disease processes for over 25 years. The spectrum of treatment ranges from conservative therapy to operative treatments, from office procedures to in operating room procedures. Advanced testing modalities, as well as biological products including skin grafting and biologicals, are all brought to bear to heal these ulcers as quickly as possible and to reduce the recurrence rate.
Skin Cancers of The Lower Extremity
Skin cancer is the most common of all human cancers, with approximately one million people in the United States diagnosed each year with some type of the disease. Cancer occurs when normal cells undergo a transformation and grow and multiply without normal controls. There are three major types of skin cancers; basal cell carcinoma, squamous cell carcinoma, and melanoma. Other unusual types of skin cancers include Merkel cell tumors and dermatofibrosarcoma protuberances. There are other skin cancers, but we will concentrate on these three, as they are the most common.
The vast majority of skin cancers are basal cell carcinomas and squamous cell carcinomas. While malignant, these are unlikely to spread to other parts of the body. They may be locally disfiguring if not treated early. A small but significant number of skin cancers are malignant melanomas. Malignant melanoma is a highly aggressive cancer that tends to spread to other parts of the body. These cancers may be fatal if not treated early. Like many cancers, skin cancers start as precancerous lesions. These precancerous lesions are changes in the skin that are not cancer but could become cancer over time. We refer to these as dysplastic. Actinic keratosis is an area of red or brown scaly rough skin which can develop into a squamous cell carcinoma. A nevus is a mole, and abnormal moles are called dysplastic nevi. These can potentially develop into melanoma over time.
At the Jersey Shore Foot and Leg Center, we have had experience treating skin cancer of the lower extremity for over 25 years. As board-certified surgeons, we have the ability to surgically remove these lesions. At the Jersey Shore Foot and Leg Center, we use a dermatoscope to help us diagnose and differentiate malignant and non-malignant lesions. Biopsy of the lesions is done in the office and sent to a specialty lab that specializes in diagnosis of lower extremity biopsies. After the biopsy returns, depending on the diagnosis, certain treatment options will be offered to the patient. At the Jersey Shore Foot and Leg Center, we approach skin cancers with combined expertise of the dermatologist, cancer surgeon, and an oncologist, if necessary.
In sum, surgical removal is the mainstay of skin cancer treatment for both basal cell and squamous cell carcinoma. Our experience as board-certified surgeons of the lower extremity gives us the advantage of planning the surgical intervention with the least potential for complications. If you are concerned about a suspicious lesion on your lower extremity, do not hesitate to contact the Jersey Shore Foot and Leg Center and set up an appointment for an evaluation of your suspicious lesion.
We specialize in the treatment of lower extremity wounds. There are many different reasons for wounds to occur. Some are from vein disease others from diabetic neuropathy still others from arterial disease. Regardless of the reasons we have the experience and expertise to treat even the worst wounds. Please call for a evaluation