Anatomy of Venous Ulceration

Question 1

is the inguinal region/groin a region of the lower limb or abdomen?

Answer 1

lower limb

Question 2

describe arterial supply to upper limb

Answer 2

subclavian > becomes axillary > becomes brachial (+ deep brachial) > becomes radial and ulnar at level of elbow) > superficial and deep palmar arches > metacarpal and digital arteries (end arteries)

Question 3

what are end arteries?

Answer 3

the only blood supple to a given area of the body (no collaterals)
e.g - digital arteries

Question 4

describe the arterial supply to the lower limb

Answer 4

external iliac > becomes femoral artery (and deep femoral) > becomes popliteal artery behind knee > becomes anterior and posterior tibial arteries below knee > becomes dorsalis pedis, medial and lateral plantar arteries, arcuate artery and metatarsal and digital arteries

Question 5

what are the perforating arteries?

Answer 5

branch off from deep femoral vein to supply the back of the thigh

Question 6

where is neck pulse?

Answer 6

anterior to sternocleidomastoid at level of upper border of thyroid cartilage

Question 7

what are the 2 reasons for ischaemia?

Answer 7

reduced arterial perfusion pressure

increased venous drainage pressure (DVT, external compression etc)

Question 8

give 4 differences between superficial and deep veins

Answer 8

superficial = small and thin, deep = large and thick
superficial = in superficial fascia, deep = run deep to deep fascia in muscular compartments
superficial =  very variable, deep = more predictable
superficial = drain into deep veins, deep = in NVBs

Question 9

what is superficial fascia and whats contained within it?

Answer 9

subcutaneous tissue

contains loose connective tissue, fat, superficial vessels, cutaneous nerves, lymphatics and sweat glands

Question 10

describe deep fascia

Answer 10

tough, sheet like dense connective tissue

white appearence

Question 11

what does deep fascia do?

Answer 11

covers body deep to skin and superficial fascia and divides limbs into compartments (intramuscular septa)

Question 12

name deep fascia in upper limb

Answer 12

pectoral
deltoid
brachial
antebrachial

Question 13

name the deep fascia of the lower limb

Answer 13

fascia lata (thigh)
iliotibial (lateral thigh)
crural fascia (leg)

Question 14

describe the course of the cephalic vein

Answer 14

arises from lateral dorsal venous arch in hand, continues along lateral limb into deltopectoral groove and drains into axillary

Question 15

describe the course of the basilic vein

Answer 15

arises from medial dorsal venous arch and continues up medial limb and drains into brachial veins

Question 16

what is the medial cubital vein?

Answer 16

connects cephalic and basilic veins at elbow

Question 17

what is the most common variant of upper limb vasculature?

Answer 17

median vein of forearm splits into medial cephalic and basilic veins which then become cephalic and basilic veins

Question 18

what is the course of the great saphenous vein?

Answer 18

from medial dorsal venous arch in foot, travels anterior to malleolus up medial side of limb and drains into femoral vein

Question 19

what is the course of the small saphenous vein?

Answer 19

arises from lateral dorsal venous arch, travels up posterior midline of the leg and drains into popliteal vein

Question 20

what are vena comitantes>

Answer 20

veins surrounding an artery encased in a vascular sheath which benefit from the pulsation of the artery as it helps push blood up the vein
(only in deep veins)

Question 21

what are perforating veins?

Answer 21

allows flow of blood from superficial veins into deep veins

Question 22

what 2 factors aid unidirectional blood flow in veins?

Answer 22

venous valves

musculovenous pump

Question 23

what can cause incompetent valves and what are the consequences of this?

Answer 23

old age, dilation of vessel

reverse flow from deep into superficial veins causing varicose veins

Question 24

how can immobility or valve failure cause thrombosis and ulcers?

Answer 24

both lead to chronic venous insufficiency which can result in venous stasis which can result in thrombosis/embolism or superficial microcirculatory deficiencies which result ulceration

Question 25

describe the progression to venous ulceration

Answer 25

increased venous pressure >damages blood vessels in skin > skin becomes dry, itchy and inflamed > skin cant heal due to bad blood supply > skin breaks down

Question 26

where are limb ulcers most common?

Answer 26

gaiter area (medial aspect of distal leg due to great saphenous)

Question 27

what is the general pattern of lymphatics in the limbs?

Answer 27

lymphatics follow the veins

Question 28

what are the paths of superficial lymphatics?

Answer 28

arise from plexuses in fingers and hands and follow cephalic and brachial veins basilic = to lateral axillary nodes cephalic = to apical axillary nodes which drain into subclavian lymphatics

Question 29

what are the paths of deep lymphatics in the upper limb?

Answer 29

follow deep veins drain into lateral axillary nodes axillary nodes drain into subclavian lymphatics

Question 30

where does lymph from lateral and medial hand end up?

Answer 30

``` lateral = apical nodes medial = lateral pectoral nodes ```

Question 31

describe the path of superficial lymphatics in lower limb

Answer 31

follow saphenous veins great = superficial inguinal > external iliac/deep inguinal small = popliteal nodes > deep inguinal > external iliac

Question 32

describe the path of deep lymphatics in the lower limb

Answer 32

follow deep veins > drain into popliteal lymph nodes > deep inguinal nodes > external iliac nodes