Flashcards in Leg Ulcer Management Deck (58):
Compression therapy is the mainstay of venous ulcer treatment.
Bacterial colonisation of chronic wounds always adversely affects healing.
Moist wound healing is better than dry wound healing.
Venous insufficiency is the most common cause of leg ulcers.
Up to 50% of patients with chronic venous insufficiency have a history of leg injury.
Venous ulcers that are not complicated by infection typically have minimal exudate.
F Exude copious exudates – yellowish fibrinopurulent, irregularly-shaped adherent exudates may be seen at the base of the ulcer
Risk factors for arterial ulcers include diabetes, smoking, hyperlipidaemia, hypertension, obesity and age.
Venous ulcers will often be associated with hair loss, atrophy, cold surrounding skin, and thickened toenails.
F Arterial ulcers.
Capillary refill time in the setting of venous ulcers is usually prolonged.
F Arterial ulcers,
Immobility is necessary for pressure ulcer development
Impaired nutritional states along with low albumin and immobility can lead to epidermal moisture and vapour loss which leads to breakdown of the stratum corneum barrier
Arterial ulcers are usually located over pressure points, such as the toes and ankles, and are sharply demarcated with little granulation tissue and a punched-out appearance.
Arterial ulcers often have a necrotic-appearing wound base.
Arterial ulcers demonstrate the 6 P’s – pulseless, pain, pallor, poikilothermia, punched-out defect, pressure point location
The most characteristic lesion of the diabetic foot is a mal perforans ulceration.
Neuropathic ulcers most characteristically develop over the pressure points of the 2nd and 3rd metatarsal heads, and the great toes.
F 1st and 5th metatarsal heads, and great toes.
Venous ulcer pain is often described as a burning pain
Pain is more common with venous disease.
F Arterial disease.
Claudication and rest pain are characteristic of arterial ulcers
An ankle-brachial index (ABI) of 1.5 or higher is normal.
F 1.0 – 1.3
ABI of 0.4 or less may indicate severe arterial disease.
Neuropathic ulcers are typically a punched-out defect with a thick surrounding callus.
Probing of sinuses and deep ulcers is not a sensitive method for detecting bone infection.
F Is highly sensitive.
Care must be taken in using compression in patients with chronic heart failure – compression of the lower extremities can lead to an increase in preload volume and exacerbate their condition.
The Unna boot is a moist zinc oxide-impregnated paste bandage that hardens to inelasticity.
Multi-layer compression bandages provide no benefit over single-layer bandage systems.
F Multi-layer are superior.
The overall standard composition of multilayer compression bandages is: a wool or cotton layer, one or two elastic wraps, and a self-adherent wrap to hold all the layers in place and to maintain the proper position of the bandage on the leg.
Multilayer compression provide pressures of 60-80mmHg at the ankle and 30mmHg below the knee.
F 40-45mmHg at the ankle, 17mmHg below knee.
Aspirin has been associated with improved healing speed for venous ulcers.
T Via its anti-inflammatory action and its action on haemostatic mechanisms.
Pentoxifylline should not be used as an adjuvant to compression therapy.
F Effective adjuvant – 800mg tds.
In an acute wound, infection risk is greatest during the first 72-96hours after injury.
Detection of microorganisms from chronic leg wounds typically represents infection.
Predisposing factors for infection and colonised wound response include advancing age, diabetes, immune compromise, obesity, impaired circulation, malnutrition and remote infection.
Topical antibiotics should be used for leg ulcers.
F Use is controversial.
A moist wound environment induces acute wounds to re-epithelialize up to 40% faster than air-exposed wounds.
Debridement is the process of removing necrotic, devitalised tissue and foreign matter from a wound.
Regarding wound dressings for leg ulcers, hydrogels (eg Intrasite) are semitransparent, soothing, and do not adhere to wounds.
Regarding wound dressings for leg ulcers, alginates (eg. Kaltostat) are not absorbent or haemostatic.
F Are absorbent and haemostatic.
Regarding wound dressings for leg ulcers, alginates are best for highly exudative wounds, and partial or full-thickness wounds.
Regarding wound dressings for leg ulcers, hydrocolloids (eg Duoderm) are transparent, create a bacterial barriers and adhere without a secondary dressing.
F This is true for film dressings (eg Opsite, Tegaderm).
Regarding wound dressings for leg ulcers, hydrocolloids are indicated for partial- or full-thickness wounds, and stages 1-4 pressure ulcers.
Regarding wound dressings for leg ulcers, alginates require a secondary dressing.
Regarding wound dressings for leg ulcers, foams (eg Allevyn) are absorbent and conform to body contours.
Large wounds with a great amount of necrotic debris are particularly poor candidates for surgical debridement.
F Good candidates.
Surgical debridement is the treatment of choice for fulminant infection.
Mechanical debridement can be performed by applying wet-to-dry dressings, whirlpool baths and high-pressure irrigation
Wet-to-dry debridement does not affect viable wound tissue.
F Lifts away viable tissue within the wound.
Autolytic debridement involves using occlusive and semiocclusive dressings to promote a moist environment to accelerate the autolytic process.
Dressings suitable for autolytic debridement include hydrocolloids, hydrogels, alginates, and transparent films.
Autolytic debridement is typically more painful than wet-to-dry debridement.
Biosurgical debridement involves the application of maggots.
Enzymatic debridement is slower than autolytic debridement.
Enzymatic debridement commonly uses topical preparations of collagenase and papainurea.
The most common cause of graft failure is infection of the ulcer bed.
Lipodermatosclerosis does not affect ulcer healing.
F Poor prognostic factor.
Regarding graft types; epidermal grafts include cultured epidermal autografts and allografts
Regarding graft types; dermal replacements include integra