Skip to main content
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1995 Jul;77(4):270–272.

Evaluation of vascular and metabolic deficiency in patients with large leg ulcers.

P Balaji 1, J G Mosley 1
PMCID: PMC2502329  PMID: 7574318

Abstract

A consecutive series of 50 patients with large leg ulcers (surface area > 100 cm2) were investigated for evidence of arterial, venous and nutritional problems. Arterial insufficiency was found in 34%, venous reflux in 50%. A group of eight patients had no arterial or venous problem but had serious deficiencies of vitamin C and zinc. Arterial bypass was performed successfully in 15 of the 17 patients with arterial disease. All patients had a mesh split-skin graft. The 25 with venous incompetence had compression bandaging; in these patients the ulcer had healed on discharge but 10 had recurrent ulceration within 6 months. The leg ulcers in patients with corrected arterial insufficiency healed significantly more rapidly than those with venous incompetence. The ulcers in those with nutritional deficiency healed promptly after skin grafting and correction of the deficiency. It is important to be aware of arterial insufficiency and nutritional deficiency in patients with leg ulcers, as such deficiencies may contribute to the non-healing of an apparently straightforward leg ulcer.

Full text

PDF
270

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Callam M. J., Harper D. R., Dale J. J., Ruckley C. V. Arterial disease in chronic leg ulceration: an underestimated hazard? Lothian and Forth Valley leg ulcer study. Br Med J (Clin Res Ed) 1987 Apr 11;294(6577):929–931. doi: 10.1136/bmj.294.6577.929. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cornwall J. V., Doré C. J., Lewis J. D. Leg ulcers: epidemiology and aetiology. Br J Surg. 1986 Sep;73(9):693–696. doi: 10.1002/bjs.1800730905. [DOI] [PubMed] [Google Scholar]
  3. Cullen K. W., Timperley A. J., Clarke J. A., Eldad A. Surfasoft, a new graft dressing. Burns Incl Therm Inj. 1988 Feb;14(1):71–76. doi: 10.1016/s0305-4179(98)90049-3. [DOI] [PubMed] [Google Scholar]
  4. Faure H., Peyrin J. C., Richard M. J., Favier A. Parenteral supplementation with zinc in surgical patients corrects postoperative serum-zinc drop. Biol Trace Elem Res. 1991 Jul;30(1):37–45. doi: 10.1007/BF02990340. [DOI] [PubMed] [Google Scholar]
  5. Goode H. F., Burns E., Walker B. E. Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture. BMJ. 1992 Oct 17;305(6859):925–927. doi: 10.1136/bmj.305.6859.925. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Goode H. F., Penn N. D., Kelleher J., Walker B. E. Evidence of cellular zinc depletion in hospitalized but not in healthy elderly subjects. Age Ageing. 1991 Sep;20(5):345–348. doi: 10.1093/ageing/20.5.345. [DOI] [PubMed] [Google Scholar]
  7. Kreis R. W., Vloemans A. F. Fixation of skin transplants in burns with SurfaSoft and staples. An analysis of the results. Scand J Plast Reconstr Surg Hand Surg. 1987;21(3):249–251. doi: 10.3109/02844318709086452. [DOI] [PubMed] [Google Scholar]
  8. Lees T. A., Lambert D. Prevalence of lower limb ulceration in an urban health district. Br J Surg. 1992 Oct;79(10):1032–1034. doi: 10.1002/bjs.1800791015. [DOI] [PubMed] [Google Scholar]
  9. Löwik M. R., Hulshof K. F., Schneijder P., Schrijver J., Colen A. A., van Houten P. Vitamin C status in elderly women: a comparison between women living in a nursing home and women living independently. J Am Diet Assoc. 1993 Feb;93(2):167–172. doi: 10.1016/0002-8223(93)90833-7. [DOI] [PubMed] [Google Scholar]
  10. Mantero-Atienza E., Beach R. S., Sotomayor M. G., Christakis G., Baum M. K. Nutritional status of institutionalized elderly in south Florida. Arch Latinoam Nutr. 1992 Sep;42(3):242–249. [PubMed] [Google Scholar]
  11. Moffatt C. J., Franks P. J., Oldroyd M., Bosanquet N., Brown P., Greenhalgh R. M., McCollum C. N. Community clinics for leg ulcers and impact on healing. BMJ. 1992 Dec 5;305(6866):1389–1392. doi: 10.1136/bmj.305.6866.1389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Nelzén O., Bergqvist D., Lindhagen A. Venous and non-venous leg ulcers: clinical history and appearance in a population study. Br J Surg. 1994 Feb;81(2):182–187. doi: 10.1002/bjs.1800810206. [DOI] [PubMed] [Google Scholar]
  13. Penn N. D., Purkins L., Kelleher J., Heatley R. V., Mascie-Taylor B. H., Belfield P. W. The effect of dietary supplementation with vitamins A, C and E on cell-mediated immune function in elderly long-stay patients: a randomized controlled trial. Age Ageing. 1991 May;20(3):169–174. doi: 10.1093/ageing/20.3.169. [DOI] [PubMed] [Google Scholar]
  14. Schraibman I. G. The significance of beta-haemolytic streptococci in chronic leg ulcers. Ann R Coll Surg Engl. 1990 Mar;72(2):123–124. [PMC free article] [PubMed] [Google Scholar]
  15. Skene A. I., Smith J. M., Doré C. J., Charlett A., Lewis J. D. Venous leg ulcers: a prognostic index to predict time to healing. BMJ. 1992 Nov 7;305(6862):1119–1121. doi: 10.1136/bmj.305.6862.1119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Taylor T. V., Rimmer S., Day B., Butcher J., Dymock I. W. Ascorbic acid supplementation in the treatment of pressure-sores. Lancet. 1974 Sep 7;2(7880):544–546. doi: 10.1016/s0140-6736(74)91874-1. [DOI] [PubMed] [Google Scholar]
  17. Woo J., Ho S. C., Mak Y. T., Swaminathan R. A comparison of the nutritional status of elderly Chinese living in different types of non-acute care institutions in Hong Kong. J Med. 1991;22(4-5):273–287. [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES