A Clinico-Pathological Study of Ulcers of Leg

Abstract

BACKGROUND About 95% of the leg ulcers are due to vascular aetiology 1 and venous ulcers account for up to 90% of cases. 2,3 Arterial disease accounts for 5% -10%, others are due to neuropathy, usually diabetic or a combination of these diseases. 4 Diabetic ulcers are common on the toe and the heel. 5 Aims and Objectives- To compare and analyse the distribution of age, sex, systemic disease and location of the ulcer among the study group. To study the clinical features of various types of leg ulcers.  To study the usefulness of applied investigations for the effective management.  To study the order of aetiological prevalence of various leg ulcers in India, particularly in Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry. MATERIALS AND METHODS RESULTSAbout 48% of leg and foot ulcers are due to vascular aetiology and arterial ulcers alone account for 32% and venous ulcers 16% in our study. Traumatic ulcer constituted next major category (24%). Diabetic ulcers constituted 18.67% among leg ulcers in our study. CONCLUSIONThis is unlike other studies, about 95% of leg ulcers are due to vascular aetiology and venous ulcers account for upto 90% and 5%-10% arterial ulcers. Diabetic ulcers constituted 18.67%, a relatively higher number as compared to western countries (5%-10%). Gay and Spencer's in 1868 wrote two important books on venous ulcers, which stressed the role of deep vein thrombosis and other lesions of arteries and veins (both superficial and deep) in the aetiology of leg ulcerations. Gay also described perforating ankle veins and suggested use of the term venous ulcerations. 2 Linton drew attention to incompetence of communicating calf veins as potential cause of venous ulcerations. 3 'Financial or Other Competing Interest': None. Submission 24-01-2018, Peer Review 18-02-2018, Acceptance 23-02-2018, Published 05-03-2018. Corresponding Author: Ganesan Vinayagam, 216, Cuddalore Road, Mudaliarpet-605004, Pondicherry. E-mail: ganeshvinayag@gmail.com DOI: 10.14260/jemds/2018 From the 10 th and 18 th centuries various physicians including Halu, Abbas, Avicenna, Falopio and Pare attributed ulceration of the leg to accumulation of black bile and believed that ulcerations of the leg served useful purpose in getting rid of those live substances. 4 The prevalence of leg ulcer is probably between 0.18% and 1% of the population. 5 The site of ulceration is analysed, around 90% of the ulcers were present in the gaiter area, 2% in the foot and 8% in the leg. 6 During the past three decades considerable knowledge has been gained regarding the anatomy, physiology, pathology and management of chronic leg ulcers. Despite all this, the management of leg ulcers is a fertile field for experimentation. Various studies have been conducted and a number of procedures and techniques have evolved with varying degree of success. It is common to see patients with different types of ulcers due to various aetiology and underlying systemic diseases. Moreover, leg and foot ulcers form ...