Is It a Graze or a Chronic Ulcer?

Chronic ulcers differ greatly to skin grazes. The distinction is important.

Chronic ulcers are difficult to treat, and are very slow healing because they contain no skin cells within the ulcerated area. The only way the skin can seal the ulcer is to close in on it from the outside in – a big feat considering how large ulcers can grow.

Grazes can be shallow, or deep enough to cause bleeding, but if cleaned and protected, will quickly build skin cells across the wound and from within, sealing themselves over 5-10 days.

Stages of Chronic Ulcers

Chronic venous insufficiency (CVI) is the cause of chronic ulcers, therefore the early stages of chronic venous insufficiency may indicate the commencement of a chronic ulcer.

The stages of CVI, in no particular order, include:

Pigmentation – a brown discolouration of the skin above the ankle, caused by leakage of blood cells out of blood vessels.

Lipodermatosclerosis – thickening skin, that feels hard, not like usual suppleness and pliability. The veins can also feel hard to the touch.

Varicose Eczema – the skin can appear red, wet, scaly, or ‘angry’.

Swelling – the leg above the ankle swells, giving the appearance of an inverted champagne bottle.

Ulceration can occur as an early stage or later stage symptom of chronic venous insufficiency.

Treatment

The best form of treatment for your leg ulcer will depend on exactly why the ulcer has occurred. An accurate diagnosis is necessary, therefore you should:

Visit your GP: Request a referral to a Vascular Surgeon.

Visit a Vascular Surgeon: During your visit, your accurate medical history will be recorded and you will undergo a physical examination with special reference to venous and arterial disease, diabetes and rheumatoid arthritis. You will also undergo an assessment of veins as well and a swab/biopsy of wound will be taken to identify infection or malignancy.

It is very important to disclose your full medical history with the surgeon, because seemingly small details can be pivotal in the correct diagnosis of your chronic ulcer. Please inform the surgeon of previous:

Minor injuries (because many ulcers begin as very minor injuries that would normally be expected to heal)

• Venous or Arterial surgeries
• Lower body surgeries (leg, knee, ankle, foot)
• Cramps
• Problems with your mobility
• DVT
• Varicose vein surgery
• Skin cancers

The vascular surgeon will refer you to have, or will perform themselves, a formal assessment of the arterial circulation using the hand-held Doppler and measurement of the ankle-brachial index. This instrument is a very sensitive tool for assessing blood flow in the leg, which is then compared against the blood flow in the arm. The blood flows are usually the same, so if the index is different to 1.0, it will indicate an abnormality to further explore.

The surgeon may also recommend that you undertake a duplex scan (venous incompetence ultrasound) of the limb veins. This ultrasound scan will clearly identify patterns of venous reflux that can be surgically corrected in appropriate patients.

During the physical examination of the ulcer, the doctor may take a biopsy or swab to check for underlying skin cancer, or to help diagnose other underlying causes of the ulcer.