Leg ulcers in diabetics are the result of nerve damage and arterial blockage, which reduces sensitivity of leg dermis towards heat, pressure and injury, causing continued damage and subsequently neuropathic ulceration. Leg ulcers are the result of venous insufficiency, peripheral arterial occlusive disease or peripheral neuropathy.
The positioning of ulcers with associated clinical characterization like callus, edema or decreased pulses, will determine the predominant cause of the leg ulcer. Infection of a leg ulcer further increases the risk of severe damages that need to be controlled, through systemic therapy.
Important Treatment for a Diabetic Leg Ulcer
For any lower extremity ulceration, the best treatment remains prevention of ulcer development. Edema need to be well managed with help of mechanical therapy, for treating venous insufficiency. The leg needs to be elevated at the heart level for 30 min. for 3 to 4 times in a day, to decrease edema and enhance the cutaneous micro-circulation. One should also sleep with elevated leg at night, to lower down the swelling.
In active patients, compression stockings need to be used to manage the edema and treat the venous ulcer of the leg. Compression stocking increases the healing rate of ulcers and lowers the chances of its recurrence, by reducing venous hypertension, increasing fibrinolysis and improving the microcirculation of the skin. One may also make use of multilayer of compression bandages to effectively reduce the edema.
For patients with venous ulcers and arterial occlusive disease, compression therapy can be a hazardous procedure. For those, pharmacological therapy is performed, wherein drugs of enteric coated aspirin and pentoxifylline are administered that are known to significantly reduce the leg ulceration.
Diabetic patients with arterial leg ulcer should consult a vascular surgeon to determine the probability for a peripheral revascularization therapy. The therapy may involve less or more invasive vascular procedures that help to elevate the peripheral blood flow.
The arterial ulcers will only recover with sufficient tissue oxygenation that may require a need for partial amputation of the leg. Hence, a vascular surgeon must be consulted for arterial ulcers, to determine the right level of amputation, whenever necessary.
Blood Glucose Management
Intensive blood glucose management is must to slow the onset or progression of peripheral neuropathy for diabetic patients. Once ulceration initiates, treatment focuses on debridement (removal of dead or infected tissue), pressure relief and treating the core infection.
Wound debridement is a process of removing nonviable tissue that if left, within the wound might lead to infection. Debridement helps to convert a chronic wound to an acute form.
Even the hyperkeartotic tissues that raise the plantar pressures are removed. Platelets get accumulated in the debrided wound, thereby promoting the inflammatory stage of wound healing.
In case of presence of osteomyelitis along with leg ulceration, the antibiotic therapy with surgical debridement is performed, to remove the infected bone.
For diabetic leg ulcers, wound need to be kept moist and clean to prevent infection and promote granulation. Topical growth factors, silver impregnated dressings, negative pressure wound therapy and living skin equivalents are amongst the various adjunctive therapies available at the specialist end that can be employed to treat wound, during leg ulcer care.