Leg ulcers Flashcards
What are the common different types of skin ulcers?
Venous Arterial Diabetic foot ulcers Pressure ulcers Neuropathic ulcers
What are leg ulcers?
Wounds / breaks in the skin that do not heal / heal slowly.
What causes arterial ulcers?
Insufficient blood supply to the skin
What causes venous ulcers?
Pooling of venous blood and waste products in the skin
What is the pathophysiology of diabetic foot ulcers?
Loss of sensation to the feet - less likely to realise an injury
Damage to small and large blood vessels impairs blood supply + wound healing
Immune system changed - low WCC
Autonomic neuropathy
Raised blood sugar
What is a key complication of diabetic foot ulcers?
Osteomyelitis - inflammation / swelling / infection of bone
Describe the clinical features of arterial ulcers?
Associated with peripheral arterial disease - absent pulse, pallor, intermittent claudication
Develops over a long period of time
Smaller and deeper than venous ulcers
Well defined borders with a punched out appearance
Pale colour due to a poor blood supply
Less likely to bleed
Painful - worse when lying and on elevating. Improves with gravity - lowering the leg.
Describe the clinical features of venous ulcers?
Normally in the gaiter area - between top of foot and bottom of calf
Associated with chronic venous changes - itching, burning, varicose veins
After a minor injury
Larger and more superficial than venous ulcers
Have irregular borders
More likely to bleed
What investigations can be done for leg ulcers?
Ankle brachial pressure index - used to assess for arterial disease. Blood tests - FBC + CRP, HbA1c, albumin Charcoal swabs - look for infections Skin biopsy - suspected skin cancer Imaging may also be done
How are arterial ulcers managed?
Referral to vascular to consider surgical vascularisation
Lifestyle changes - smoking cessation, weight loss, increased exercise
Medical - optimise other conditions such as diabetes, start statins etc.
Surgical - angioplasty (with or without stenting) or bypass grafting.
May also need skin reconstruction with grafts
What are some risk factors for arterial ulcers?
Peripheral arterial disease Smoking Diabetes Hypertension Hyperlipidaemia Old age Obesity Physical inactivity
What are risk factors for venous ulcers?
Old age History of VTE / varicose veins Pregnancy Obesity / physical inactivity Severe leg injury or trauma
How are venous ulcers managed?
Leg elevation Weight reduction If infected - antibiotics Wound care - cleaning, debridement and regular dressing Compression bandaging
What is a neuropathic ulcer?
Peripheral neuropathy means that there is a loss of protective sensation, leading to repetitive stress + unnoticed injuries. This often then leads to painless ulcers forming on the pressure points.
What is peripheral neuropathy?
Damage to the nerves in the peripheral nervous system that causes pain, numbness or weakness
