Venous leg ulcers are the most common type, accounting for the majority of chronic leg wounds. They develop when the veins of the leg fail to return blood efficiently to the heart, leading to chronic venous hypertension that damages the skin and underlying tissue. These ulcers typically appear on the lower leg, around the ankle, are often shallow with irregular borders, and are surrounded by skin changes including discoloration, hardening, and swelling. Compression therapy is the cornerstone of treatment, since without addressing the venous problem, the ulcer cannot heal.

Arterial ulcers result from inadequate blood flow to the lower extremity, typically caused by peripheral artery disease. They are often found on the toes, heels, and bony prominences, tend to be deep with well-defined edges, and are frequently very painful. Patients may have a history of leg cramps with walking, diminished pulses, and skin changes from poor circulation. Restoring blood flow through medical optimization and, when needed, vascular procedures performed by our colleagues in vascular surgery is essential for healing.

Diabetic neuropathic ulcers form on areas of high pressure on the bottom of the foot in patients with diabetic peripheral neuropathy. Pressure ulcers develop on bony prominences, especially in patients with limited mobility. Mixed ulcers have features of more than one type and require complex care.

Our approach begins with thorough evaluation. We examine the wound carefully, assess the surrounding skin, evaluate circulation through pulse examination and noninvasive vascular studies when indicated, and check for signs of infection. We obtain cultures when infection is suspected and order imaging to assess for underlying bone involvement. We coordinate with vascular specialists, infectious disease specialists, primary care providers, and wound care centers to provide comprehensive, multidisciplinary care.

Treatment combines several elements. Debridement removes dead tissue and stimulates healing. Advanced wound dressings are selected to match the specific needs of each wound, ranging from simple coverings to bioactive products that deliver growth factors or skin substitutes. Compression is used for venous ulcers, offloading for pressure-related wounds, and infection control for any wound with signs of bacterial involvement. Patient education is essential, since healing depends on consistent care, blood sugar control, nutrition, and prevention of new injuries. Our commitment is to do everything possible to heal the wound, save the limb, and prevent recurrence.