Clinical anatomy of Venous Ulceration

Question 1

What are some regions of the upper limb?

Answer 1

Axilla, arm (brachium), elbow/cubital fossa, forearm (ante-brachium), wrist, hand

Question 2

What parts of the body does the axilla connect?

Answer 2

The upper arm and the trunk

Question 3

What are some regions of the lower limb?

Answer 3

Inguinal region/groin, thigh, knee/popliteal fossa, leg, ankle, foot

Question 4

What parts of the body does the groin connect?

Answer 4

The lower limb and the trunk

Question 5

What does each limb require?

Answer 5

Arterial supply, venous drainage and lymphatic supply

Question 6

What does the subclavian artery pass under?

Answer 6

The clavicle

Question 7

Where does the deep brachial artery bifurcate?

Answer 7

In the cubital fossa

Question 8

What is the direction of arterial blood flow in the arm?

Answer 8

Subclavian artery, axillary artery, brachial artery, deep brachial artery, ulnar artery + radial artery, deep and superficial palmar arches, metacarpal and digital arteries

Question 9

Where does the popliteal artery bifurcate?

Answer 9

Within the popliteal fossa

Question 10

What is the other name for the acuate artery?

Answer 10

Dorsal arch

Question 11

What is the direction of arterial blood flow in the leg?

Answer 11

External iliac artery, deep femoral artery, perforators, femoral artery, popliteal artery, anterior + posterior tibial arteries, dorsalis pedis + medial and lateral plantar arteries, acuate artery + deep plantar arch, metatarsal and digital arteries

Question 12

How do you limit blood loss to an injury?

Answer 12

Apply pressure proximal to site of injury-press on pulse point and apply tourniquet

Question 13

Where in the neck is the bifurcation of the common carotid artery?

Answer 13

Anterior to sternocleidomastoid muscle at the level of the upper border of thyroid cartilage

Question 14

Where can the brachial artery pulse be found?

Answer 14

Medial to biceps tendon in the cubital fossa

Question 15

Where can the radial artery pulse be found?

Answer 15

Lateral to the tendon of flexor carpi radialis

Question 16

Where is the femoral artery pulse located?

Answer 16

Inferior to the midpoint of inguinal ligament

Question 17

Where is the popliteal artery pulse found?

Answer 17

In the popliteal fossa (immediately behind the knee)

Question 18

Where is the posterior tibial artery pulse located?

Answer 18

Between the posterior border of the medial malleolus and the achilles tendon

Question 19

Where can the dorsalis pedis artery pulse point be palpated?

Answer 19

Medial to the tendon of extensor hallucis longus distal to the ankle joint

Question 20

What is ischaemia?

Answer 20

Inadequate oxygenation of cells/tissues/organs due to an interruption to blood supply

Question 21

What are some causes of reduced arterial perfusion pressure?

Answer 21

Left ventricular failure, arterial bleed, arterial rupture (aneurysm), occlusion of lumen, arterial spasm, external compression of arterial supply

Question 22

What are some causes of increased venous drainage pressure?

Answer 22

Right/congestive heart failure, DVT, external compression

Question 23

What are some features of superficial veins?

Answer 23

Smaller, thinner, run in superficial fascia, highly variable, drain into deep veins

Question 24

What are some features of deep veins?

Answer 24

Larger, thicker, run into deep fascia, more predictable, often occur in neurovascular bundles

Question 25

What is another name for superficial fascia?

Answer 25

Subcutaneous tissue

Question 26

What are some features of superficial fascia?

Answer 26

Loose connective tissue and fat, varies in depth, superficial blood vessels, cutaneous nerves, lymphatics and sweat glands

Question 27

What are some features of deep fascia?

Answer 27

Relatively tough and sheet like, dense connective tissue, usually white (glistening), named

Question 28

What does deep fascia divide the limbs into?

Answer 28

Compartments

Question 29

What does deep fascia cover?

Answer 29

Most of the body deep to the skin and superficial fascia

Question 30

What does deep fascia form when it invests muscles?

Answer 30

Intramuscular septa

Question 31

What are some superficial veins of the upper limb?

Answer 31

Cephalic vein and Basilic vein

Question 32

What does the cephalic vein arise from and where is it found?

Answer 32

Arises from the dorsal venous network; found at the lateral aspect of limb in the deltopectoral groove

Question 33

What does the cephalic vein drain into?

Answer 33

The axillary vein

Question 34

Where does the cephalic vein become the subclavian vein?

Answer 34

At the lateral border of rib 1

Question 35

What does the basilic vein arise from and where is it found?

Answer 35

Arises from the dorsal venous network; found on medial aspect of limb

Question 36

What does the basilic vein drain into?

Answer 36

Brachial vein at level of mid-arm

Question 37

What are some superficial veins of the lower limbs?

Answer 37

Great saphenous vein and small saphenous vein

Question 38

Where is the great saphenous vein and where does it arise from?

Answer 38

Found on medial aspect of limb; arises from dorsal venous arch

Question 39

What does the great saphenous vein drain into?

Answer 39

The femoral vein at the femoral triangle

Question 40

Where does the small saphenous vein arise from?

Answer 40

The dorsal venous arch

Question 41

Where can the small saphenous vein be found and where does it drain into?

Answer 41

Found on the posterior midline of limb; drains into popliteal vein posterior to knee

Question 42

What are the only two veins which aren't bilateral?

Answer 42

The SVC and the IVC

Question 43

What does Vena comitantes mean?

Answer 43

Accompanying vein-the vein surrounds an artery

Question 44

How does surrounding an artery benefit the vena comitantes?

Answer 44

Benefits from the pulsation of the artery when enclosed within a vascular sheath

Question 45

What is the function of venous valves?

Answer 45

Ensure unidirectional blood flow against gravity

Question 46

What can incompetent valves cause?

Answer 46

Reverse flow into superficial veins, causing weak and dilated varicose veins

Question 47

What is the direction of venous blood flow?

Answer 47

Superficial vein, perforating veins, deep veins

Question 48

What does the musculovenous pump do?

Answer 48

Pushes blood back towards the heart

Question 49

How does venous ulceration arise?

Answer 49

Venous pressure increases, damages blood vessels in skin, skin becomes dry/itchy/inflamed, can't heal well due to poor blood supply so begins to break down

Question 50

How can a DVT arise?

Answer 50

Due to venous stenosis

Question 51

What can happen if a thrombus breaks off?

Answer 51

It can occlude the vessel and cause an infarction

Question 52

What happens if a thrombus becomes lodged in the pulmonary artery?

Answer 52

Infarction of one lung

Question 53

What happens if a thrombus becomes lodged in the pulmonary trunk?

Answer 53

Complete occlusion by a saddle embolus arrests the circulation

Question 54

What do lymphatics generally follow?

Answer 54

Veins

Question 55

Where do the superficial lymphatics of the upper limb arise?

Answer 55

Arise from the plexus in fingers and hand

Question 56

What is the direction of flow in the superficial lymphatics that follow the basilic vein in the arm?

Answer 56

Basilic, cubital lymph nodes, lateral axillary lymph nodes

Question 57

Where do the superficial lymphatics that follow the cephalic vein in the upper arm drain into?

Answer 57

Mainly to apical axillary lymph nodes

Question 58

Where do the deep lymphatics of the upper arm drain into?

Answer 58

Lateral axillary lymph nodes

Question 59

What is the direction of flow of the superficial lymphatics of the lower limbs that follow the great saphenous vein?

Answer 59

Great saphenous vein, superficial inguinal nodes, external iliac nodes or deep inguinal nodes

Question 60

What is the direction of flow of the superficial lymphatics of the lower limbs that follow the small saphenous vein?

Answer 60

Small saphenous vein, popliteal nodes, deep inguinal nodes, external iliac nodes

Question 61

What veins do the superficial lymphatics of the lower limb follow?

Answer 61

The saphenous veins

Question 62

What veins do the deep lymphatics of the lower limbs follow?

Answer 62

The deep veins

Question 63

What is the direction of flow of the deep lymphatics of the lower limb?

Answer 63

Drain into popliteal lymph nodes, then deep inguinal nodes and into the external iliac nodes

Question 64

Where do the external iliac nodes of the lower limbs drain into?

Answer 64

Drain into the common iliac nodes and enter the lumbar lymphatics

Question 65

What is the elliptical incision used for?

Answer 65

Removing small skin lesions

Question 66

What are some complications of elliptical incisions?

Answer 66

Nerve injury, bleeding from superficial veins

Question 67

How should elliptical incisions be closed?

Answer 67

Using several simple interrupted sutures

Question 68

What kind of arteries are Digital arteries?

Answer 68

End arteries-only blood supply to an area

Question 69

Where is the most common area for venous ulceration?

Answer 69

The medial aspect of the distal thigh (known as the gaiter area)