Leg ulcer in connective tissue disease

Objective: We assessed the aetiology of leg ulcers in patients with connective tissue diseases and analysed the outcome after an appropriate causative treatment. Methods: Retrospective clinical study on 20 consecutive leg ulcer patients with rheumatoid arthritis (n = 12), progressive systemic sclerosis (n = 7), systemic lupus erythematodes (n = 1). Results: The following pathologies were found to be relevant: macrocirculation (total 17; arterial 10, venous 10, combined 3), cutaneous leukocytoclastic vasculitis (5), steroid-induced skin atrophy (8), venous stasis in ankle ankylosis (9), dystrophic calcinosis (3). The following interventions were performed: arterial revascularisation (9), saphenectomy (7), split skin transplantation (17), amongst five times under immunosuppression because of vasculitis. At the end of the study 13 were healed completely, 4 had improved (90% healed), 3 remained unchanged; moreover, 1 contralateral below-knee amputation, one patient died. Conclusions: Leg ulcers in patients with connective tissue diseases have commonly a multifactorial aetiology. Improving arterial and venous macrocirculation is the most important step. Three quarters of patients require a split skin transplantation to heal or improve their chronic wound under improved conditions.