Improving the treatment of leg ulcers

Letter

MJA 2001; 175: 670

As one cannot spend one's life standing in a pool, it seemed to me that there should be some way of duplicating this in a more convenient form. After some experimentation, I have found a reasonably easy way is to use two sphygmomanometer cuffs, with the tubes connected by suitable plastic tubing, and containing enough water to about 3/4 fill one of the bladders. An insert is put in the canvas of one, to enable it to be worn around the waist (theoretically it should be at the height of the heart, but in practice there seems little difference if it is worn at waist height), and the other is wrapped around the ankle with the ulcer (see Box).

The leg cuff is applied first, while still empty, over whatever dressing is preferred on the ulcer, and maybe a layer of cotton wool, as the cuff material can be rather coarse. Then the waist cuff is put on; this contains the water, which can be felt running down and expanding the lower cuff. The importance is that the pressure exerted will balance that in the veins, cannot exceed this, and will vary according to whether one is standing, sitting, or lying down, when water will run back into the upper cuff.

As an ophthalmologist I don't get to treat many people with leg ulcers, but I have had vein problems myself for a number of years, with periodic small ulcers, none of which have ever grown to any size, and have healed in four weeks, most in rather less time, with the above management. Obviously, I don't claim it will cure everyone, but it does provide a more scientific pressure which is equal all round the leg, and balances the venous pressure at all times. In my case the pressure, when standing, works out at 66 mm Hg. Even if there is arterial insufficiency, the pressure is only that which is in the veins.

No doubt, a purpose-made appliance which is easier to apply and covers a larger area could be produced.

Graeme W Johnson
Ophthalmologist, 4th Floor, 39 East Esplanade, Manly, NSW 2095.
grapamATnsw.bigpond.net.au

1. McMullin GM. Improving the treatment of leg ulcers. Med J Aust 2001; 175: 375-378.

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