Multifactorial Insights into Chronic Leg Ulcers: Experience from a Tertiary Wound Care Center

Objective: To analyze the demographic features, etiological factors, clinical profiles, and treatment outcomes of patients with chronic lower extremity wounds managed at a tertiary wound care center. Materials and Methods A retrospective review was conducted on 783 patients treated for chronic lower extremity wounds between May 2014 and January 2022. Patient demographics, comorbidities, wound etiology, microbiological data, histopathological findings, and treatment modalities were evaluated. Patients with trauma-related wounds or incomplete follow-up were excluded. Results: The mean age was 62.1 years, with females comprising 32% of the cohort. Diabetes was the leading cause of chronic lower extremity wounds (68.6%), followed by PAD in non-diabetic patients (21%), venous insufficiency (5.6%), and stasis dermatitis (3%). Pyoderma gangrenosum and drug reactions represented less common etiologies. Among diabetic foot ulcer patients, 55% were Wagner Grade 1–2, while 45% were Grade 3 or higher. Smoking prevalence was 74%, and associated with longer healing times. Wound closure was achieved via skin grafting in 58% of cases, secondary intention in 21%, and amputation in 12%. Negative pressure wound therapy was employed in 15% of cases. Staphylococcus aureus, Enterococcus spp., and Pseudomonas spp. were the most commonly isolated pathogens. Pyoderma gangrenosum was histologically confirmed in 6 patients. Conclusion: Diabetes and PAD remain the predominant etiologies of chronic lower extremity wounds. High smoking prevalence, delayed referrals, and advanced Wagner grades at presentation underscore the importance of early multidisciplinary intervention and standardized treatment protocols. The judicious use of negative pressure wound therapy, tailored antibiotic stewardship, and consideration of non-infectious etiologies in non-healing wounds are vital. Nationwide multicenter prospective studies are needed to develop uniform strategies for reducing the clinical and economic burden of chronic lower extremity wounds. a multidisciplinary approach are essential to improving outcomes and reducing the risk of limb loss.