Etiology and management of leg ulcers – an enigma

Neerja Puri, Ashutosh Talwar


Chronic leg ulcer is defined as a defect in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Leg ulcers are debilitating and greatly reduce patients' quality of life. The common causes are venous disease, arterial disease and neuropathy. Management of patients with chronic ulcers has to be multidisciplinary and should include detailed history, physical examination, investigations, basic and newer treatment modalities, and educating patients on issues of correct foot care and the importance of seeking early medical advice.



Leg ulcer, management, venous ulcer, arterial ulcer, diabetes, insufficiency, neuropathic

Full Text:



Ryan TJ. The epidemiology of leg ulcers. In: Westerhof W, ed. Leg Ulcers: Diagnosis and Treatment. Amsterdam: Elsevier Science Publishers; 1993. P. 19-27.

Baker SR, Stacey MC, McKay AG. Epidemiology of chronic venous ulcers. Br J Surg. 1991;78:864-7.

Margolis DJ, Bilker W, Santanna J, Baumgarten M. Venous leg ulcer: incidence and prevalence in the elderly. J Am Acad Dermatol. 2002;46:381-6.

Baker SR, Stacey MC, Singh G et al. Aetiology of chronic leg ulcers. Eur J Vasc Surg. 1992;6:245-51.

Miller OF 3rd, Phillips TJ. Leg ulcers. J Am Acad Dermatol. 2000;43:91-5.

Renton EJ. Pharmacological treatments of venous leg ulcers. J Wound Care. 1999;8:195-7.

Mekkes JR, Westerhof W. Venous ulceration. Lancet. 1993;342:121-2.

Partsch H. Investigations on the pathogenesis of venous leg ulcers. Acta Chir Scand. 1988;544:25-9.

Falanga V, Eaglstein W. The trap hypothesis of venous ulceration. Lancet. 1993;341:1006-8.

Valencia IC, Falabella A, Kirsner RS, Eaglstein WH. Chronic venous insufficiency and venous leg ulceration. J Am Acad Dermatol. 2001;44:401-21.

Junger M, Steins A, Hahn M, Hafner HM. Microcirculatory dysfunction in chronic venous insufficiency (CVI). Microcirculation. 2000;7:3-12.

Leu HJ. Morphology of chronic venous insufficiency - light and electron microscopic examinations. Vasa. 1991;20:330-42.

Singer AJ, Clark RAF. Cutaneous wound healing. N Engl J Med. 1999;341:738-46.

Cornwall JV, Dore CJ, Lewis JD. Leg ulcers: epidemiology and aetiology. Br J Surg. 1986;73:693-6.

Nelzen O, Bergqvist D, Lindhagen A. Leg ulcer etiology - a cross sectional population study. J Vasc Surg. 1991;14:557-64.

Nelzen O, Bergqvist D, Lindhagen A. Venous and non-venous leg ulcers: clinical history and appearance in a population study. Br J Surg. 1994;81:182-7.

Phillips TJ. Chronic cutaneous ulcers: etiology and epidemiology. J Invest Dermatol. 1994;102:38-41.

Kahle B, Hermanns HJ, Gallenkemper G. Evidence-based treatment of chronic leg ulcers. Deutsches Arzteblatt Int. 2011;108:231-7.

Meyer FJ, Burnand KG, Lagatolla NRF, Eastham D. Randomized clinical trial comparing the efficacy of two bandaging regimens in the treatment of venous leg ulcers. Br J Surg. 2002;89:40-4.

Hafner J, Trueb RM. Management of vasculitic leg ulcers and pyoderma gangrenosum. Curr Probl Dermatol. 1999;27:277-85.

Persoon A, Heinen MM, van der Vleuten CJ et al. Leg ulcers: a review of their impact on daily life. J Clin Nurs. 2004;13:341-54.

Van Gent WB, Wilschut ED, Wittens C. Management of venous ulcer disease. Br Med J. 2010;341:1092-6.

Caputo WJ, Beggs DJ, DeFede JL et al. A prospective randomised controlled clinical trial comparing hydrosurgery debridement with conventional surgical debridement in lower extremity ulcers. Int Wound J. 2008;5:288-94.

Lok C, Paul C, Amblard P et al. EMLA cream as a topical anesthetic for the repeated mechanical debridement of venous leg ulcers: a double-blind, placebo-controlled study. J Am Acad Dermatol. 1999;40:208-13.

Bello YM, Phillips TJ. Management of venous ulcers. J Cutan Med Surg. 1998;3:6-12.

Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for venous leg ulcers (Cochrane Review). The Cochrane Library, Issue 1. Oxford: Update Software, 2001.

Nelson EA, Bell Syer SEM, Cullum NA. Compression for preventing recurrence of venous ulcers. Cochrane Database of Systematic Reviews. 2000.


  • There are currently no refbacks.

ISSN: 1560-9014