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What Is It ?

A skin ulcer simply means a loss of a patch of skin. There are many causes for this. In your case, the cause comes from the veins just under the ulcer. Your veins are a little bigger than normal. These are called varicose veins because they look a bit like a wine bottle from ancient Greece (varix).

A varicose vein is a superficial (close to the surface) vein lying under the skin. It has swollen because of overspill of blood from veins running deep in the muscles of the legs. This happens because certain valves that allow the blood to flow from the superficial to the deep veins of the leg and not the other way around are not working any more. The problems with your varicose veins are not their size, but the high pressure and sluggish flow of blood inside them. These cause aching, cramping, itching, staining of the skin, eczema and finally ulcers.
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The ulcers are often very painful. They can bleed and get infected. In the long term they can range from a minor handicap to possible serious illness. Most varicose ulcers will heal. The key to the treatment is to put continuous pressure on the underlying veins. One of the best ways of doing this is to squeeze the veins with bandaging. The latest way of bandaging is to use four different types of bandage all at the same time. This is what you may have. The pressure dressing is far more important than any ointments, powders, granules, or dressings on the skin. Sometimes the blood supply is not good to the leg. The skin is starved of blood as well as being damaged by the pressure. The doctors may need to do special tests and suggest other treatment for this.

The Operation

Prior to the operation you will need a period of bed rest and elevation of the legs to reduce the swelling (oedema) of the legs. At the same time you will be given antibiotics to reduce the inflammation (cellulitis) of the skin around the ulcers. The first step of the operation is for the ulcers to be measured. A probe test may be done to check the circulation.

A specimen of the discharge is taken for the laboratory to examine for the presence of any bugs in the ulcers. This will guide the antibiotic treatment that you will need in the future. The ulcers are cleaned.

A non-stick dressing is put on the ulcer. Four layers of special bandages are wrapped around your leg from the knee down to the base of your toes. The doctors will arrange to see you the following week to decide if you need to take antibiotics.

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Possible Complications

Minor problems include:

  • The bandage is too tight
  • The bandage is too loose
  • Discharge coming through the bandage.
This can be easily solved by removing the bandage, cleaning the ulcer and putting on new bandages and applying “just the right” pressure.

More severe problems include:

  • Severe pain
  • Fever (signs of infection)
  • Bleeding.

If the infection is very localised, it can usually be settled by taking antibiotics for a couple of weeks. Spreading of the infection into the tissues lying deep under the ulcer or into your bloodstream is a serious condition. It will require you to stay in the hospital and take antibiotics given into one of your veins and possibly an operation to clean the infected tissues.

Bleeding is very rarely a serious problem. Most of the time it consists of some oozing under the bandages and can usually stopped by applying some extra pressure. Very rarely it will require another operation to stop it.
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Before The Operation

All your old dressings are taken off. You are given a general check over.

After – In Hospital

There may be some discomfort. Painkillers such as paracetamol should be all you need to control the pain. If the painkillers are not strong enough, contact the dressing clinic or your own doctor.

After – At Home

The bandages need to stay on day and night until the ulcers have healed. That is until the skin has grown over again. Three out of four ulcers will have healed within 12 weeks or so. Most of the others will have healed within a further six weeks.

It is very rare for an ulcer not to heal. Sometimes other treatment, such as a stay in hospital, is needed. Do not get the bandages wet or they will become smelly and unpleasant.

Wash the rest of yourself with ordinary water and soap. You can cover the bandages with polythene bags to keep them dry. Just eat your normal diet. Eat less if you are overweight.

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