A chronic foot, ankle or leg ulcer is one that fails to heal by 50% over a 4 week period.
There are many reasons why an ulcer may not heal. Your doctor needs to make sure there is no infection and there is adequate blood flow into and out of the leg and foot.
Smoking cessation is essential.
Your nutrition and protein intake need to be adequate.
If the ulcer still fails to improve, advanced grafting options are available.
Amniotic membrane grafting is an example of a tissue graft that can be used.
This tissue has been used for more than a century. Amnion is derived from human placenta (it is found on the innermost layer of the placenta which has two layers). Amnion grafts contain collagen and extracellular matrix (the structure that supports cells). It also contains molecules called cytokines that promote tissue growth. Other chemicals are present that help reduce inflammation and prevent infection.
In the following example, the patient sustained a significant injury to the lower leg.
At initial presentation, the ulcer was black and had dead tissue on the surface. Despite conservative therapy including debridement, dressing changes and antibiotics, the ulcer would not improve.
Amniotic membrane grafting was used and the ulcer finally healed after only a few weeks.
The first picture on the left shows an ulcer that has failed to heal despite standard of care treatment 
Amniotic membrane graft placement led to rapid healing of this traumatic ulcer
Grafting can be performed in the office setting.
Amniotic membrane grafts can be placed safely in the office setting.
Sometimes grafting needs to be done in the operating room.
Depending on the patient, medical conditions and ulcer characteristics, the graft may need to be applied in the OR.
Exposed bone needed a thicker amniotic membrane graft. 
Here the bone is completely covered with graft. This case is still a work in progress.
If you have a chronic ulcer on the foot, ankle or lower leg that has failed to heal you should consider a consultation with Dr. Nodelman. Amniotic membrane grafting may be an option to help you heal.