Chronic leg ulcers - please help

[HalfaCider]

I'm desperate for advice and any treatment options for chronic leg ulcers that refuse to heal. My FIL has gone from being a funny, happy man to a house bound, depressed man over the last year. He has also aged dreadfully. His leg ulcers are on both legs and require dressings being changed every day by a district nurse. They constantly leak liquid causing the bandages to quickly become uncomfortable and unsightly. Due to an additional health condition his mobility is now low and he has lost confidence. He uses a walker at home and wheel chair on the rare occasions he goes out. My DH and I are his only family and after endless tests, antibiotics and NHS input, we are being told there are no other treatment options. Just keep changing the bandages and hope for the best. It has been nearly 12 months like this and he is only mid 70's.

We even went private and were told the same - veins are working well, so keep going with compression bandages. I just can't believe with all the medical advances, that there aren't more technological treatments or even something 'out there' like leaches. Has anyone got experience or could recommend a medical professional that we could see? Happy to travel anywhere in the UK. I can't believe a scratch on his leg has ended up like this...

Try medical grade honey, on NHS. Ask for dermatology consult. Can have grafts done if necessary.

Thank you - never heard of medical grade honey. Will look at this.

Oddly I read this article yesterday -

https://apple.news/AyrqjASHTRtygIGwlY7mhaQ

Sounds similar, in so much that the ulcers weren’t healing. I hope you find something that works, it must be extremely debilitating for your FIL.

What is the cause of the leg ulcers?
Has he had Doppler studies to assess his arteries?
Has he seen a vascular consultant?
Is he overweight?
What is the other chronic health condition and Does he have ankle issues?

Is he in compression bandages?
Does he elevate his legs when resting?

No help whatsoever but be grateful the nurses are coming in as often as they are. We had to fight to get them at all and one day they changed one leg and left saying they didn't have time to do both. We struggled to get them changed twice a week.

Keep them raised, weirdly doggy puppy pads have been a godsend.

Does he smoke?

My mum had them for a couple of years and it seemed nothing would clear them. She had regular dressing changes from the district nurses.
She had dementia and then unfortunately had a stroke which left her doubly incontinent and unable to weight bare. So she had to move into a residential home. Within 2 months of that move the ulcers had gone. The home used medical honey and obviously changed the dressings daily and from the first week we could see an improvement.

My mum was changed to daily apinate dressings when she had stubborn ulcers, which improved them greatly.

Most leg ulcers are related to poor mobility andleg swelling.
If arteries are normal the solution is compression bandaging to squeeze the fluid out of the tissues and high elevation of the legs when resting to prevent the legs swelling and if possible exercise to make the calf muscles actively pump fluid from the legs to the rest of the body.
Maintaining a healthy weight is important too.

Problems with the veins can contribute too but the

Sorry I posted too soon. The type of dressing is much less important than it being done often enough with compression. Not all patients can have compression though eg if they have arterial disease.

Things like honey are not the answer for the majority of patients who just need good nursing care and to get their legs up.

I run specialist clinics for people with leg ulcers if OP is able to give a bit more info.

Does he have heart failure?

My dm developed them when she got cancer, she was always underweight so not necessarily connected

This might not be relevant for your FIL, but I listened to a podcast with Dr Jason Fung a few years ago and I remember him mentioning some of his diabetic patients with ulcers that would simply not heal. He treated them with a fasting regime, so basically getting blood sugar levels lower and it cured them. Just something to consider.

Thank you so much for all the replies. To answer some questions: initial cause of ulcer was a scratch which developed. Previous cellulitis. It has had several infections treated with antibiotics. FIL has had poor circulation and swelling before, but private consultant said veins were working well and there is nothing they would do surgically. Doppler etc has been done.

He has now lost a lot of weight (had extensive testing to rule out anything sinister) and has been told this is likely due to all the leaking fluid. Main underlying condition is non-alcoholic liver cirrhosis which he has lived with for years. Sadly they have never found out what caused it, so it is not being treated. I know this can impact healing. Doesn't smoke and no heart failure. He has had limited proper compression because on the times they did it, he was in agony and his legs swelled terribly. Tissue team advised he may not be suitable for compression. He does keep legs up.

Private consultant advised a different compression sleeve which he can control tightness on, so this will be next step. I know we are lucky with the district nurses - we just don't seem to move forward. We expected a few months, but nearly a year has been incredibly hard on him.

So … The liver cirrhosis will be causing oedema as the liver is producing fewer proteins which are needed to keep the fluid within blood vessels. It seeps out into the tissues because of this.

His immune system is also impaired for the same reason. The recurrent cellulitis has damaged the lymphatics which are now struggling to drain the extra fluid.

If his arteries ( arterial supply) he CAN have compression safely but it will be painful initially. He needs enough pain relief to break the vicious cycle. Once the ulcers are improving compression will be less painful.

If his mobility is poor he will not be using his muscles to push fluid upwards.

The three most important things are

1. Good pain relief to allow him to tolerate compression. Morphine is often required.

2 Good nutrition - protein shakes and puddings
3 . high elevation ie feet need to be above hips as much as possible. Think
toes at the same height as nose. Put an old
suitcase under the foot end of his mattress. Encourage him to get into bed for a few hours every afternoon. When out of bed he needs a high recliner chair.

Essentially he needs to try and break the vicious cycle. This will be very hard to resolve as the liver is a chronic condition .

Ask GP to check his iron levels too.

I hope this is helpful

Really helpful and clear. Thank you. We will press on!

Has he had Doppler studies and vascular assessment?
Also many trusts have specialist Tissue Viability Nurses - ask GP or DN for referral

Yes he has had all tests such as doppler and is under the Tissue Viability team. They haven't been great TBH.

I’m sorry to hear that @HalfaCider .The suggestions from the poster above look helpful and I hope your dad is feeling better soon.