Leg Ulcers Flashcards
Define “leg ulcer”
Any break in the skin of the lower leg, above the ankle, present for more than 4 weeks
The majority of leg ulcers are arterial in nature. True/False?
False
Majority are venous ulcers
List characteristics of a venous ulcer
- Shallow, large, sometimes painful
- Due to incompetent valves > venous stasis + increased venous pressure.
- Common above medial malleoli (ankle bone) and on shin
- superficial
ABPI is measured for ulcer patients. What are the normal limits for ABPI?
0.9-1.3
ABPI of less than 0.8 indicates what?
Vascular disease
ABPI of more than 1.5 indicates what?
Calcification
When would a wound swab of an ulcer be done?
If smelly/painful/exudative/enlarging
Name 2 de-sloughing agents
Hydrogel
Honey
What is the gold standard treatment for leg ulcers?
Compression bandaging + non-adherent dressing
Where do diabetic and arterial ulcers tend to present?
Feet Pressure sites (heel)
What are the risk factor for venous ulcers?
o Obesity o Immobility o Varicose veins o Recurrent DVT o Age
What are the signs of a venous ulcer?
o Oedema of the lower legs
o Hyperpigmentation
o Stasis eczema
What is the name of the condition described as woody tethered skin affecting lower leg (invited champagne bottles)?
Lipodermatosclerosis
What is slough?
Debris on ulcer (dead skin, bacteria etc). It must be removed for the ulcer to heal
What should leg ulcers be cleaned with?
Warm tap water and soap
After it has healed, must wear compression stockings to prevent recurrence.
What is is called when there are inflamed blood vessels?
Vasculitis
Why do arterial ulcers occur?
Due to inadequate arterial blood supply to skin
Where do arterial ulcers occur?
Occurs distal at dorsum of foot or between toes
What are the risk factors for arterial ulcers?
o Coronary heart disease
o Peripheral arterial disease
o Obesity and immobility
o Diabetes
What are the signs of an arterial ulcer?
o Night pain o Hairlessness o Cold peripheries o Absent pulses o Pain alleviated when leg dangling off bed
What are the investigations for arterial ulcers?
ABPI
Duplex ultrasound
ECG
What is the management for arterial ulcers?
Improve circulation- Exercise, angioplasty, bypass
Treat infections, remove dead tissue
What are the signs of malignant ulcers?
o Rolled edges
o If the ulcer does not seem to be healing
o No vascular cause
What are ulcers with a lack of sensation?
Neuropathic ulcers
