الفهرس 
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Abstract
Summary
Chronic leg ulcer is defined as a defect in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. chronic ulceration of the lower legs is a relatively common condition amongst adults, one that causes pain and social distress. The condition affects 1% of the adult population and 3.6% of people older than 65 years.
Leg ulcers are debilitating and greatly reduce patients’ quality of life. The common causes are venous disease, arterial disease, and neuropathy. Less common causes are metabolic disorders, hematological disorders, and infective diseases.
As many factors lead to chronic lower leg ulceration, an interdisciplinary approach to the systematic assessment of the patient is required, in order to ascertain the pathogenesis, definitive diagnosis, and optimal treatment. A correct diagnosis is essential to avoid inappropriate treatment that may cause deterioration of the wound, delay wound healing, or harm the patient. The treatment of chronic ulcers of the lower extremities presents a therapeutic challenge. There is clear evidence suggesting that causal treatment should have priority. A comprehensive diagnostic evaluation including vascular,metabolic, and physical aspects asmentioned above is essential at the start of treatment.
It is useful to divide leg ulcers into those occurring in the gaiter area and those occurring in the forefoot because the aetiologies in these two sites are different. At least two aetiological factors can be identified in one third of all lower limb ulcers. Venous ulcers most commonly occur above the medial or lateral malleoli. Arterial ulcers often affect the toes or shin or occur over pressure points. Neuropathic ulcers tend to occur on the sole of the foot or over pressure points.
An ideal management plan for patients with chronic leg ulcers should involve an early strategic and coordinated approach to delivering the correct treatment option for each individual patient, based on accurate assessment of the underlying pathophysiology.
The management of leg ulcers should include a detailed history of the onset of the problem, examination of the legs and skin, investigations, and modalities of treatments. Successful management of leg ulcers requires a clear diagnosis, establishment of a treatment plan, accurate monitoring, and adherence to the plan as the ulcer decreases in size. Education and training is vital for all those involved in caring for patients
with chronic ulceration.
The diagnosis and treatment of the underlying cause of a leg ulcer are as important as the treatment of the ulcer itself. A failure to appreciate this elementary concept is responsible for the majority of recurrent ulcers. Even when this point has been grasped, accurate diagnosis may be hampered by lack of familiarity with methods of investigation. The most frequent error is the failure to recognize that an ulcer is ischemic in origin, and many ischemic ulcers are undoubtedly made much worse by tight compression bandaging, in the mistaken belief that they are venous. As the latter are by far the most common, this is an understandable mistake, but in an aging and cigarette-smoking society, ischemic laceration is now seen with increasing frequency
Clinical course of the ulcer can suggest its etiology. Possible considerations to rule out include diabetes; hypertension; hyperlipidemia; coronary artery disease; alcohol and tobacco use; thyroid, pulmonary, renal, neurologic, and rheumatic diseases; peripheral vascular disease; deep vein thrombosis; specifically cutaneous factors including cellulitis, trauma, and recent surgery.
The basic principles of treatment are to remove or treat precipitating cause, for example, surgical intervention, to promote circulation and improve venous return, for example, compression therapy, to promote healing, for example, wound care, lifestyle changes, symptom management, and to promote preventative care, for example, health education, current treatments for chronic leg ulcer include surgery, sclerotherapy, compressive therapy (conventional therapy), and adjuvant pharmacotherapy.
The traditional planning for reconstruction of the lower extremity has been approached according to the location of the defect. Divided into thirds, gastrocnemius muscle flap for proximal third, soleus muscle flap for middle third and free flap transfer for the distal third of the leg. Like the reconstructive ladder concept, this traditional approach can be useful but the surgeon must individualize each wound and choose the initial procedure that can yield the best chance of success and avoid morbidity.
The researchers are inventing newer modalities of treatments for patients with chronic leg ulceration, so that they can have better quality life and reduction in personal financial burden.