AbstractChronic leg ulcers (CUL) are the most frequent and economically the most loss-making disorder, the importance and significance of which is not in doubt in the structure of public health and disorder that lasts for a very long period and severely limits the activity of patients. The problems of ulcer represent a wide spectrum of etiology, pathology, severity and morbidity. They can occur in children, adult and elderly. No age spared, no sex is spared. Varying etiological factors and presence of complicated systemic diseases make the treatment of ulcer very difficult. It is necessary to do a careful clinical examination of ulcer to arrive at the diagnosis and plan for appropriate treatment. Surgical treatment of ulcers may be directed toward modifying the cause of the ulcer or treating the ulcer itself by a graft, flaps or primary closure. Various studies have been conducted and a number of procedures and techniques have evolved with varying degree of success. Treatment of these ulcers forms a challenging task as well. So the present study was attempted to analyze a surgical management of the ulcers more over the leg and foot. This study comprises of 86 cases who admitted in the surgical ward between November 2010 to September 2012. It included cases of skin ulcers like stasis ulcers, diabetics with leg ulcers, traumatic ulcers, arterial ulcers and others more over lower limb. It excludes mucous ulcer. All patients were initially examined in the outpatient department and were admitted. A detailed history was collected with particular reference to onset, duration and type of lesion, socioeconomic strata and occupational factors and systemic diseases. Any histories of similar ulcers and past history were also noted. A thorough systemic and local examination was carried out. The morphological features of ulcers i.e. – site, size, shape, floor, edge. Margin, number, distribution, any discharge, surrounding skin, regional lymph nodes and associated diseases like varicose veins, eczema or patches were noted. A provisional diagnosis of ulcer type done on the basis of clinical examination. Plan for appropriate surgical treatment like primary closure, skin grafting and various flaps. The outcomes of surgical management of ulcer like acceptance or rejection were noted at the time of discharge. The data entry and analysis was done. The highest number of cases was found to be ulcer associated with diabetes mellitus (44.2%), traumatic ulcer (41.9%) and less commonly due to vascular (9.3%) and malignant (4.7%) etiology. Incidence of ulcer in the study group were found to be maximum (65.1%) in the age group of 40 years and above followed by 34.9 % in the age group of 20 to 40 years. The incidence of ulcer more common in males (73.3%) than females (26.7%). Diabetic ulcer being relatively common in males, more prevalent in patients above the age of 40 years and above. The commonest organism cultured from the wounds was found to be staphylococcus (24.4%). Though the causative factors are varied, diabetes mellitus and venous insufficiency were by far the more common factors. Underlying vascular disorders are the main etiological factors for ulcers with diabetes forming a major risk factor. Diabetes was the commonest disease associated with chronic ulceration. Majority of ulcers 67 (77.9%) were underwent skin grafting while 11 (12.8%) and 8 (9.3%) were accounted for primary closure and flaps respectively. The ulcers underwent for skin grafting and primary closure have mean timing for heal was 10 days while those underwent for flaps has 13 days. Traumatic ulcers were operated with skin grafting 25 (69.4%), primary closure 6 (16.7%) and flaps 5 (13.9%). More than 2/3rd (31) of diabetic ulcers were treated with skin grafting.

Keywords: Surgical modalities, ulcer management.