Leg ulceration is a common condition among the old and also among people with certain risk factors, as will be discussed below. An ulcer is a wound developing due to cracking or breaking of the skin that takes a long time to heal. Around 5-6 days. Leg ulcers are generally of two kinds: arterial and venous.
Arterial vs Venous Ulcer
The main difference between arterial and venous ulcers is that they arise due to different underlying reasons, which makes their symptoms, treatment, healing time, wound type, pain property, and many other characteristics different from each other. Although they are both ulcers, they differ from each other in a variety of ways.
An arterial ulcer is a type of chronic wound developed due to the damaging of skin tissue as a result of ischemia. Ischemia is a condition in which there is a lack of blood flow to the tissues from the heart. Since bringing blood to the different parts of the body is the work of the arteries thus the name arterial ulcer is given to this type of wound.
Venous ulcer is a type of chronic wound development due to damaging of skin tissue as a result of lack of proper circulation of the blood back to the heart or due to stagnation of the blood mostly associated with added pressures. Since veins are responsible for bringing blood back to the heart hence, this wound is called a venous ulcer.
Comparison Table Between Arterial and Venous Ulcer
| Parameters of Comparison | Arterial Ulcer | Venous Ulcer |
| Cause | Arterial ulcers are caused due to a lack of blood supply from the heart. | Venous ulcers are caused due to a lack of blood returning to the heart. |
| Occurrence | They occur in areas of the leg that have to bear the weight of the person. | They occur mainly on the medial side of a leg of a person. |
| Bleeding | Arterial ulcers do not bleed profusely. | Venous ulcers are known to bleed heavily. |
| Type of Wound | The wound is well defined in the case of arterial ulcers. | The wound is irregular in the case of venous ulcers. |
| Pain | Arterial ulcers are very painful. | Venous ulcers show periodicity in pain. |
What is Arterial Ulcer?
The identifying feature of an arterial ulcer is its punched-out appearance. The wound of an arterial ulcer has well-defined edges and is pale in colour, and has necrotic tissue around it. This wound is chronic and takes days to heal. The long time it takes to heal is because of the lack of blood supply to this area.
Ulcers are caused due to underlying regions like lack of oxygenated blood to the tissue causing it to break and cause the wound. This wound is also known to bleed heavily associated with pain. Leg pain is common and is the most at night. The wound occurs in weight-bearing areas of the body like the tips of toes, heels, phalangeal head and so on.
The leg usually turns cold at this spot, the skin turns dry, and in extreme cases can also turn into infected gangrene. Sometimes exudate may come from these wounds in case there is an infection, or else there is no exudate at all.
The risk factors of an arterial ulcer include diabetes, improper footwear, atherosclerosis, inborn foot deformity, smoking, vascular disease, obesity and any such disease that may prevent blood flow to the body. The leg is the most commonplace occurrence of an ulcer as it is a peripheral part of the blood where the blood reaches the last.
What is Venous Ulcer?
The identifying feature of a venous ulcer is its irregular appearance. The wound is granular in appearance and itchy, unlike arterial ulcers. This is caused when the blood from the leg is not returned to the heart and remains stagnant in the affected area.
The underlying cause thus does not always oxygenated blood to reach this area and hence cause tissue to almost undergoes oxygen starvation and hence crack up and bleed continuously. Usually, the site of occurrence of venous ulcers is the medial side of the leg and aspects such as the gaiter of the leg.
Sometimes hair may develop from the wound. Usually, they are also painless however show periodicity of pain. Usually, the pain is during the nighttime only. The affected area, however, remains warm, unlike arterial ulcers that occur cold to touch or perceive.
The risk factors of venous ulcers are pregnancy, diabetes, obesity, thrombosis, malnutrition, vein surgeries, varicose vein, and any such reason causing the blood to be stagnant in the area. Dilation of veins occurs at the leg, which is a common symptom of venous ulcers.
Main Differences Between Arterial and Venous Ulcer
- Arterial ulcers occur due to a lack of oxygenated blood to a certain body from the heart, whereas venous ulcers occur due to a lack of blood going to the heart.
- Arterial ulcers do not bleed as such, but venous ulcers bleed a lot.
- Arterial ulcers have a distinctive wound. Venous ulcers do not have a distinct wound.
- Pulse beat is sometimes absent in a leg with the arterial ulcer, whereas in the case of venous ulcer, the pulse beat of the leg can be felt as normal.
- The leg appears cold in the case of arterial ulcers, whereas in the case of venous ulcers, the leg stays warm.
Conclusion
Lack of oxygen to the leg and its tissues are the main cause of arterial or venous ulcers. To prevent ulcers from developing, the risk factors as stated above must be checked regularly and avoided. Also, regular exercise can help. In case of venous ulcers elevating the leg for some time may help. In case of arterial ulcers, compression stockings and antibiotics are helpful.
Occurring mostly in the elderly proper education must be given to patients and the people taking care of them so that they can effectively take care of the affected and help cure the ulcer by 5-7 days.
References
- https://journals.lww.com/aswcjournal/fulltext/2010/09000/Arterial_Ulcer_Checklist.11.aspx
- https://www.sciencedirect.com/science/article/pii/S0738081X06001350
- https://www.hindawi.com/archive/2013/413604/cta/