Sickle cell leg ulcers are a common manifestation of sickle cell disease, affecting around 75% of patients over the course of their disease.(1) Sickle cell ulcers can be both painful and debilitating, and tend to heal only slowly. It has been shown that most ulcers will eventually heal on their own following a prolonged period of bed rest,(2) but this is not practical in most situations, either at home or in a hospital environment.

The active management of sickle cell ulcers can be challenging and frustrating. The mainstay of treatment relies on basic wound management techniques, including debridement of devitalized tissue, control of infection, assurance of adequate circulation, and maintenance of a moist wound environment.(2) Leg ulcers that persist beyond 6 months may require additional intervention, but very limited clinical trial data are available to support possible treatment strategies. Anecdotally, blood transfusion, skin grafting, zinc sulfate, hyperbaric oxygen, arginine butyrate, and topical herbal applications are thought to offer some benefit.(1) In addition, an Unna boot applied to the lower extremity and covered with an ace wrap has been shown to be beneficial for patients with edema. Other approaches  that have met with some success include the use of honey-based preparations and human tissue-engineered skin.(2)

One important requirement in the management of sickle cell ulcers is management of the patient’s pain. The pain associated with sickle cell ulcers is not only a source of distress for patients, but can affect wound treatment by precluding manipulation of the wound. Indeed, a patient in severe pain is likely to be noncompliant to recommended treatment approaches, preferring to manage the wound him/herself in a way that does not increase pain sensation. A degree of pain control can be achieved through use of topical anesthesia, regional anesthesia,  opioid analgesics, and other regional medications. Often the pain of a sickle cell ulcer must be managed by a pain specialist. 

Successful management of sickle cell ulcers relies on interventions from experienced and qualified healthcare professionals. To improve your knowledge and understanding of this and other complex wound care issues, consider studying for a certification in wound care. For information about the ways that this can benefit your career, please visit www.woundeducators.com.

References

1.              Minniti CP, Eckman J, Sebastiani P et al. Leg ulcers in sickle cell disease Am J Hematol 2010; 85:831-833.

2.              Treadwell TA, Willis AC, Brem H. Sickle Cell Ulcers. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008