Title: Clinicopathological Study of Chronic Lower Limb Ulcers and Management
Authors: Dr Akkidas. Suvarchala. M.S, Dr Tabbassam Aura M.S, Dr Shaik Sohail
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.05
Abstract
Introduction: Ulceration of the lower extremity is a common condition that causes significant discomfort and disability. An ulcer is defined as a disruption of the skin with erosion of the underlying subcutaneous tissue. This breach may extend further to the contiguous muscle and bone. The pathophysiological mechanisms underlying ulcer formation are multi-factorial and include neuropathy, infection, ischemia, and abnormal foot structure and biomechanics.
Aims and Objectives: To compare and analyse the distribution of age, sex, systemic disease in lower limb ulcers among 100 cases of the study group. To study the clinical features of various types of leg ulcers. To study the usefulness of applied investigations. To carefully manage the condition.
Patients and Methods: The present study “CLINICOPATHOLOGICAL STUDY OF CHRONIC LOWER LIMB ULCERS AND MANAGEMENT” was done at Department of General Surgery in Andhra Medical College, King George Hospital during the period between July 2015 to October 2017.
Source of Data: During this period all the lower limb ulcers which were admitted to various surgical units and attended surgical OPD at King George Hospital were included in this study.
Type of study: Prospective study with detail history taking & clinical examination
Statistical Analysis: Statistical analysis was done by using MS Excel 2007.
Observations and Results: The most common cause of lower limb ulcer was found to be Diabetes mellitus (29%) followed by traumatic ulcer (18%).Youngest patient was 13years and oldest 70years.Case volume was found to be maximum in the age group >50years (46%) signifying that ulcers occur frequently in older age group. Males were found to be predominantly affected (70%).Diabetic ulcers were found to be highest in the age group >50 years (58.62%). There was marked male preponderance (86.2%).Venous ulcers were found to be greatest in the age group >50 years (64.2%). Males were found to be maximally affected (57.14%).Long saphenous system is the most common venous system affected in venous ulcers (85.72%). Trendelenberg procedure combined with GSV Stripping & split thickness skin graft was the procedure employed in treatment of al 12 cases. Peripheral vascular disease in the affected limb was diagnosed by absent peripheral arterial pulsations and Color Doppler. Atherosclerosis was found to be the most common cause of arterial ulcers (57.14%). Among Trophic ulcers, 60% were in diabetics, 20% in hemiplegics and 20% in Hansen’s disease. Most common malignant ulcer in my study was Marjolins ulcer (60%) all of which had history of burns in the past. Remaining were Squamous cell carcinoma (40%). The most common exudate in the present study is serous (54.16%) followed by purulent(43.76%) and greenish exudates (2.08%). Lower limb ulcers were found to be more common in left limb (60.49%). Out of total 100 patients of chronic lower limb ulcers,41% underwent debridement, 25% underwent split skin graft, 14% underwent Trendelenburg operation with Great/short saphenous vein ligation with perforator ligation, 10% underwent amputation,7% underwent lumbar sympathetectomy and rest 3% underwent plastic surgery consultation for reconstruction.
Conclusion: Multi-disciplinary team approach and establishing specialized wound care centres appear to confer a significant, positive impact on reducing recurrent ulcerations and amputations. A detailed knowledge of the clinical picture, pathogenesis, diagnostic tests, treatment modalities, and differential diagnosis of leg ulcerations is essential in planning the optimal treatment strategy.
Keywords: chronic ulcer, diabetic ulcer, venous ulcer, debridement, grafting.
