Chronic Leg Ulcers (CLU) are wounds on the legs of individuals with Sickle Cell Disease that do not heal up within the normal natural time frame. CLU is a defect below the level of the knee and above the foot. They are a major cause of morbidity (incapacitation) in patients with sickle cell disease but rarely causes death in these patients. Sickle Cell Disease has a wide spectrum of presentation, and the effect of genetic variations may modify leg ulcer severity. They usually need the input of extra medical efforts to heal up. The duration of healing may be as short as 3 months and may also take up to 5 yrs. The size of the wounds may also extend to over 300cm2 in area depending on the age of the wound. A major issue with this unhealing wounds is that after much efforts and pain to get them healed up, they break up again a few weeks or months after.
SCHAF in 2015 came
to the rescue of about 19 patients using a more modern method of leg ulcer
treatment known as Compression Therapy.
Chronic Leg Ulcers in individuals with Sickle Cell Disease have been attributed majorly to venous incompetence (inability
of blood in the veins to drain back properly), hence causing oedema that then
bursts out as ulcers. Microbial infections may also help to delay healing. Compression Therapy makes use of a four-layer coban bandaging system to create the pressure
needed for adequate blood and nutrient flow in the wound area in order to
enhance healing. The eighteen patients that were treated consistently for 3
months using compression bandaging had remarkable improvement in the healing of
the ulcers with complete healing in four of them. The patients were also put on
antibiotics during the first month of the study, in order to control infections. However, after the intervention stopped, most
of the wounds had a set back and 3 out of the 4 healed ulcers had broken out
again (recurrence).
Haematological parameters in
these patients were studied in order to have a better understanding of underlying
causes and proffer interventions for better management. We found that those
with low haemoglobin and elevated white blood cells and platelet counts at
steady state were at higher risks of developing leg ulcers. Improvement in
these parameters was observed with healing of the ulcers. Therefore, monitoring
of haematological parameters for improvement while controlling infections may
help in better ulcer management. The continuous application of pressure by
regular wearing of compression stockings may also help to prevent wound
recurrence.
CLU limits education, subsequent employment potential and social life. Many patients with Sickle Cell Anemia having CLU drop out of School due to prolonged hospital stay.
References
1. Ogunkeyede A.O., Babalola O.A., Ilesanmi O.S., Odetunde A.B.,
Aderibigbe R., Adebayo W., Falusi A.G. Chronic Leg Ulcers in Patients with Sickle Cell
Anemia: Compression Therapy Experience in Nigeria. Nigerian Journal of Plastic Surgery 2017;13:50-55
2. Babalola O.A.,
Ogunkeyede A.O., Odetunde A.B., Fasola F.A., Oni A.A., Babalola C. P. and
Falusi A.G. Hematological parameters in patients with sickle cell disease and
chronic leg ulcers. African Journal of Laboratory Medicine 2020; 9(1),
a1037. https://doi.org/10.4102/ajlm.v9i1.1037