Open leg: what is it and what can you do about it?

An open leg is a wound on the lower leg that does not or hardly heals. It is caused by poor blood circulation. In this way, a small wound or ulcer can develop into an open wound on the leg. There is often something you can do about it, for example by exercising more, living a healthier lifestyle or wearing a support stocking. In some cases it can be so serious that amputation of the lower leg is necessary. What exactly does open leg mean and how can it be treated?

What an open leg means

The medical name for open leg is ulcus cruris and it is an open wound on the (lower) leg. Literally it means: ulcer on the lower leg. The normal skin has partially disappeared and a usually rather irregular open wound is created. The size can vary and sometimes the wound is moist. Often this place is covered with a crust. If tissue has died, this can be seen as a black spot. If this is not treated, it can lead to such a serious infection that (part of) the leg needs to be amputated. If the wound is less serious, it may heal on its own. Normal skin tissue grows from the edges of the wall. Before an open leg occurs, there have often been complaints for a long time, such as fluid retention, varicose veins, swollen ankles or brown discoloration. Open legs are common, especially in the elderly with circulation problems. It occurs slightly more often in women than in men.

The emergence

This condition occurs when there is poor blood circulation. Blood carries oxygen and nutrients that are delivered to all cells in the body. The blood vessels continue to branch to the smallest capillaries to supply all the tissue. There are supplying blood vessels (arteries) and draining blood vessels (veins). A disorder can arise in both systems, which can ultimately lead to an open leg. The problem usually arises in the veins, where the blood has to go back up through the legs to the heart. Because the valve system in the veins no longer works properly, the blood can flow back to the legs. If a narrowing occurs in the arteries, too little oxygen and nutrients reach the tissue, causing cells to die. This can lead to very painful open spots that are very difficult to heal.

Skin infarction

Smoking is a major cause of clogging of the arterial capillaries. Capillaries are the smallest blood vessels in the body. Particularly in the small arteries in the skin, a narrowing can quickly have bad consequences for blood flow: small vessels only need to be narrowed slightly before blood flow is compromised. Sometimes an artery can suddenly become blocked by a blood clot. This is also called an embolism or skin infarction.

The phenomena

A tired and heavy feeling in the legs will usually be a first symptom of a blood circulation disorder. Over the course of the day, the ankles will become thicker due to fluid accumulation (edema). Varicose veins, eczema complaints and brown spots may develop. Sometimes subcutaneous hardening occurs. Ultimately, an ulcer will develop that is difficult to heal and an open leg will develop. The ulcer does not have to be painful, but it can be smelly and produce a lot of fluid. Usually the clearing is located near the ankle.

Diagnosis

By feeling the throbbing in the leg arteries or measuring blood pressure, a supply disorder in the arterial system can be ruled out or confirmed. An open leg is easy to recognize from the outside. Additional examination such as X-ray examination is sometimes necessary. A duplex examination is often performed as an additional examination. An ultrasound is performed in combination with a Doppler. An ultrasound can visualize the blood vessels and the Doppler can measure the direction and speed of the blood flow. If an infection is suspected, tissue can be cultured. The severity of the disorder determines which treatment method is applied.

Therapy

The most important thing is to promote blood flow from the legs towards the heart. The supply of blood flow with nutrients and oxygen ensures that the wound can heal better. A special pressure bandage can be used to promote upward blood flow. This method replaces the calf muscle pump that no longer works properly. With this bandage, the pressure around the ankles is greatest and it will gradually decrease towards the knee. This means that the blood can no longer sink back down. It only has sufficient effect if the calf muscles are also used, so walking is necessary. Swimming or cycling is also a good form of exercise. How long the treatment with a pressure bandage lasts varies. It can vary from a few weeks to many months. The bandage must be removed during the night, otherwise it can become painful. In some cases, a support stocking will always have to be worn.
If the wound on the leg is very large, a skin graft may sometimes be necessary. Pieces of skin are removed from, for example, an upper leg and placed on the wound. Sometimes it is decided to spray away certain varicose veins. If there is a supply disorder due to narrowing of one or more arteries, which prevents the open leg from healing, angioplasty of these arteries is sometimes chosen. The narrowing is removed by means of a balloon that is inflated in the artery, allowing blood to flow through it again. In exceptional cases, hospitalization is chosen, for example if the open leg has not healed after a number of months or if there is an infection. If an open leg has become serious and other methods no longer help, an amputation of the foot or lower leg can be chosen.

What you can do yourself

Movement is important so that you keep the calf muscles moving. Wear an elastic support stocking. Once your circulatory system is damaged, in most cases it will not heal. You can try to prevent a new open wound. Try to be at a good weight and if you are overweight, it is wise to lose some weight. Avoid tight clothing such as tight jeans and elastic bands. Walk in comfortable shoes and avoid high heels. High heels reduce the good pumping effect of the calf muscles. If you have to sit for a while, put your legs up. If possible, you can also raise the foot of your bed a little. These measures will help prevent fluid retention and tired legs, but there is still a chance that an open leg will develop (again) in the future.

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