Chronic skin ulcers of the lower extremities, commonly known as “rotten legs”, are mainly chronic skin ulcers of the lower and middle calves. It is often considered as a complication of vasculitis, diabetes, varicose veins, deep and superficial phlebitis, thrombophlebitis, and lymphatic obstruction diseases in their advanced stages of development. It is a common disease in surgery and is also a difficult disease, which often causes pain to patients because it does not heal repeatedly, and some ulcers even become cancerous or are complicated by severe osteomyelitis and amputation. Among all chronic ulcers of the lower limbs, the proportion of ulcers caused by venous diseases is more than 90%, and the remaining less than 10% are caused by arterial diseases, thrombo-occlusive vasculitis, lymphatic obstruction, as well as neurological diseases, metabolic disorders, blood system disorders and lipofuscinosis. It can be seen that chronic ulcers of the lower limbs are mainly caused by peripheral vascular diseases, which can be roughly divided into the following two categories: stasis ulcers, i.e. venous ulcers, mainly caused by stasis of blood in the veins of the lower limbs; the other is ischemic ulcers, also called arterial ulcers, mainly caused by insufficient blood supply to the arteries of the limbs, and ulcers caused by thrombo-occlusive vasculitis are also classified as such. The venous ulcers of the lower limbs of Yuan Baofang, the stoma wound incontinence care clinic of Nantong University Hospital, are divided into deep vein type and superficial vein type. Normal human lower limb veins can be divided into deep veins, superficial veins and the traffic branches between deep and superficial veins. There are many one-way valve-like structures DD venous valves in the venous cavity, and the action of the valves makes the venous blood flow from the lower extremities upwards, from the superficial veins back through the traffic branches to the deep veins. Once the venous valves are damaged, the venous blood backflow, resulting in increased venous pressure in the lower extremities, superficial venous expansion and tortuosity, skin dystrophy, calf skin pigmentation, eczema, dermatitis, often in the affected limbs of the inner and outer calf, shin, shin, posterior, ankle ulcers that do not heal,. The ulcers vary in size. At the beginning of the disease, it may only be an inflammatory exudate, and then the ulcer will become bigger and deeper, and often the whole layer is rotten. The skin around the ulcer becomes dark or purple-black, and the skin flakes and itches. It is more common in the lower third of the calf, more on the inside than on the outside, and the disease recurs repeatedly, with itching followed by pain, followed by ulceration to form a wound. Once the ulcer occurs, the bone is exposed and the surface becomes infected, resulting in chronic osteomyelitis. Some patients suffer for years or decades. If not treated in time, the ulcer spreads from small to large, which can lead to bone infection and eventually amputation. Therefore, once the above symptoms appear, patients should go to the vascular surgery or general surgery department of the regular hospital to find out the cause of the disease and request professional wound treatment by a certified wound therapist so as to achieve the purpose of radical treatment. In general, for the lower extremity superficial veins and traffic vein valve insufficiency, can receive surgical treatment, while with lower extremity arteriovenous fistula, simple venous surgery is not effective, for patients with deep vein thrombosis sequelae, the risk of surgical treatment may aggravate the disease, can only take conservative treatment, such as: the appropriate treatment of the wound, the use of medical elastic bandage or special elastic stockings, then the ulcer can be healed. Patients with varicose veins, . The varicose veins cause changes in hemodynamics of blood flow and inflammatory changes in the veins, resulting in slow blood flow, blockage, stasis, thickening of the vessel wall, intimal hyperplasia, narrowing of the lumen or thrombosis, resulting in local tissue ischemia, hypoxia and necrosis, resulting in a difficult-to-heal ulcer, which will not heal naturally until the venous reflux returns to normal without improving the original disease, and will only gradually worsen. Because there is no change in venous hemodynamics, poor reflux, increased local stasis, more serious ischemia and hypoxia, the ulcer surface of necrotic tissue will only expand, not shrink, which is the reason why the old rotten leg does not heal. Humans are walking upright, lower limb venous blood flow back upward must overcome the great geocentric suction. The mystery is mainly the pressure difference between the arteries and veins. The former pressure is high, the latter pressure is low, and the direction of blood flow naturally travels from high to low. In addition, there is the squeezing effect of muscle contraction when the lower limbs move, as well as the static membrane valve located inside the vein. Some people are born with weak vein walls, or the number of static valves is too little, poor structure, poor function; if usually standing still, the lower limb muscle activity is reduced, the muscle squeeze effect is not enough, the lower limb venous blood flow back is blocked, causing the pressure in the veins to rise. After a long time, the superficial veins of the lower limbs expand and thicken, and then develop to twist into a group, like a group of earthworms coiled under the skin. Patients often feel soreness and fatigue in the lower limbs, and some have edema in the back of the foot or ankle joint. If left untreated, the skin of the lower leg and ankle will become atrophied, thinner and shinier, with sparse sweat hair, darker color, eczema, and even ulcers. It is more common in hairdressers, traffic police, surgeons, nurses or people with heavy loads, and is often triggered by injuries to the skin of the lower extremities, insect bites and eczema. It is often divided into three types: ischemic, depressive, and neurological; 1. Ischemic ulcer: It is found on the distal side of the limb, i.e., toe (finger) and foot root, with severe pain, especially at night, and can be relieved by a drooping limb. The edge of the ulcer starts irregularly and later becomes jagged, with unhealthy gray-white granulation tissue covering the bottom and chronic ischemic changes in the surrounding tissue. The necrotic tissue is not in harmony with the surrounding area. Often due to arterial vasculopathy 2, bruised ulcers: preferably in the lower and mid calf, single or multiple, round or irregularly shaped. The ulcer is shallow, with hard, sloping edges, and the granulation tissue at the bottom is relatively loose, with an uneven surface, covered with purulent secretions; the surrounding skin is dark brown pigmented, with edema, eczema, itching, and other manifestations of depressive dermatitis. The pain is mild and is significantly relieved by elevation of the affected limb and cleaning of the wound. Often due to venous vasculopathy.3. Neuropathic ulcers: They occur in the metatarsophalangeal joint, ankle joint, callus pressure, foot root, and little toe joint. The ulcers are round with walled edges, deep cavities with rough granulation tissue, and thin and foul-smelling secretions. Atrophy of the surrounding tissues may occur, and there is often no obvious pain. As in the case of diabetic foot. For knowledge about diabetic foot, see the relevant blog post on this blog. Health education and prevention: 1 . First of all, the patient should pay attention to the old rotten leg, seek medical attention early, make clear the diagnosis and treatment, maintain the improvement of venous reflux, and remove the tissue stagnation. If there is a history of venous ulcers. Deep vein thrombophlebitis and venous valve insufficiency. More active treatment is required. Prevent the development and aggravation of the disease 2 . Avoid prolonged standing. Sitting for a long time and other postures. When the body is stationary standing or sitting for a long time. Blood due to gravity. The lower extremity venous valves are under greater pressure. The calf muscles are in a relatively relaxed state. Poor emptying of blood from the venous lumen. The valve is under constant pressure. When the pressure is greater than the pressure that the valve can resist. The blood in the vein regurgitates abnormally and gradually increases. Eventually, local venous stasis increases. Therefore, prolonged standing and sitting should be avoided and appropriate rest should be taken. Activity.3 Reduce all factors that increase abdominal pressure. Prevent prolonged increase in intra-abdominal pressure. Elevated intra-abdominal pressure can affect the venous blood return to the lower extremities. Causes increased venous pressure in the lower extremities. Increases the destruction of venous valves or increases the burden on the venous valves. Therefore, diseases that cause increased intra-abdominal pressure should be actively treated.4 . Elevate the affected limb to promote venous blood flow back to the lower extremity. Rest and elevate the affected limb appropriately. This can reduce the swelling of the affected limb and prevent calf ulcers. The patient elevates the affected limb. Half an hour is appropriate 3-5 times a day. Encourage walking. Improve blood circulation.5 . Prevent trauma. Because of the thin vein wall, it is easy to rupture and bleed, so we should pay attention to protect the affected limb and avoid trauma, frostbite or insect and animal bite. 6 Avoid scratching the skin. If combined with eczema, it should be treated in time. Avoid scratching and infection that may cause ulceration or aggravation.7 . When treating rotten leg, you should choose a high protein and high vitamin diet and avoid smoking and alcohol. For more information about high protein and high vitamin diet, please refer to this blog. 8. Use medical elastic bandage or special elastic stocking routinely when moving.