Leg ulcers Flashcards
Name three types of ulcers
Arterial, venous and neuropathic
What is an ulcer?
Unhealed, abnormal break in the skin or mucous membranes
What is the commonest cause of a leg ulcer?
Venous insufficiency (80%)
Briefly describe the pathophysiology of venous leg ulcers
Incompetent venous valves cause backflow and pooling = venous hypertension. WBC trapped in capillaries, activated by fibrin cuff that restricts O2 entry into tissues - inflam mediators released = tissue injury. Damages micro vessels in skin causing it to become dry, itchy and can easily break down after trauma, causing an open wound that doesn’t heal due to poor blood supply
Name some causes of ulcers
Venous/arterial insufficiency
Diabetic neuropathy
Prolonged/excessive pressure
(rare: infection, trauma, vasculitis, squamous cell carcinoma)
Venous: appearance?
Shallow
Irregular border
Granulating base
Venous: other features
Characteristically over medial malleolus
Infection prone
Associated cellulitis
Painful (worse at night)
Venous: risk factors
Previous VTE Age Varicose veins Pregnancy Obesity/inactivity Leg trauma
Venous: distribution
Gaiter region of leg (mid calf to ankle)
Venous: associated symptoms
itching, aching, bursting sensation
Venous: O/E
Varicose veins Ankle/leg oedema Haemosiderin deposition Venous eczema Lipodermatosclerosis thrombophlebitis
Venous: investigations
Duplex USS
ABPI
Swab cultures if infection is suspected
Venous: management
Leg elevation Exercise Lifestyle mods Abx if evidence of inf Compression therapy (only if ABPI>0.6)
Arterial: caused by?
Reduction in arterial bloodflow = decreased perfusion and poor wound healing
Arterial: appearance?
Small, deep punched out lesions
Well-defined borders
Necrotic base
