Leg Ulcers

Question 1

Three main types of leg ulcers

Answer 1

Arterial, venous and neuropathic ulcers

Question 2

Other types of leg ulcers

Answer 2

Vasculitic ulcers, infected ulcer, malignancy

Question 3

History of venous ulcer

Answer 3

Often painful, worse on standing, history of venous disease (varicose, DVT)

Question 4

Common sites for venous ulcers

Answer 4

Malleolar area

Question 5

Presentation of venous ulcer

Answer 5

Large, shallow, irregular, exudative and granulating base

Question 6

Associated features of venous ulcer

Answer 6

Warm skin, normal peripheral pulses, leg oedema, haemosiderin and melanin deposition, lipodermatosclerosis, atrophie blanche

Question 7

Possible investigations into venous ulcer

Answer 7

Normal ABPI

Question 8

Management of venous ulcer

Answer 8

Compression bandaging after excluding arterial insufficiency

Question 9

History of arterial ulcer

Answer 9

Painfu, especially at night and worse when legs evelated, history of arterial disease (atherosclerosis)

Question 10

Common sites for arterial ulcers

Answer 10

Pressure and trauma sites such as pretibial, supremalleolar, and distal points

Question 11

Presentation of arterial ulcer

Answer 11

Small, sharply defined, deep ulcer with necrotic base

Question 12

Possible investigations into an arterial ulcer

Answer 12

ABPI is <0.8 from presence of arterial insufficiency. Doopler studies and angiography

Question 13

Management of arterial ulcer

Answer 13

Vascular reconstruction

Question 14

Associated features with an arterial ulcer

Answer 14

Cold skin, weak or absent peripheral pulses, shiny pale skin, loss of hair

Question 15

History of neuropathic ulcer

Answer 15

Often painless, abnormal sensation, history of diabetes or neurological disease

Question 16

Common sites for neuropathic ulcer

Answer 16

Pressure sites such as sole, heel, toes, metatarsal heads

Question 17

Presentation of neuropathic ulcer

Answer 17

Variable size and depth, granulating base, may be surrounded by or underneath a hyperkeratotic lesion (callus)

Question 18

Associations with a neuropathic ulcer

Answer 18

Warm skin, normal peripheral pulses, peripheral neuropathy

Question 19

What is the difference if a neuropathic ulcer is an neuroischaemic ulcer

Answer 19

There are cold, weak or absent pulses

Question 20

Possible investigations into neuropathic ulcer

Answer 20

ABPI <0.8 implies neuroischaemic ulcer, Xray to exclude osteomyelitis