Leg Ulcers Flashcards
(20 cards)
Three main types of leg ulcers
Arterial, venous and neuropathic ulcers
Other types of leg ulcers
Vasculitic ulcers, infected ulcer, malignancy
History of venous ulcer
Often painful, worse on standing, history of venous disease (varicose, DVT)
Common sites for venous ulcers
Malleolar area
Presentation of venous ulcer
Large, shallow, irregular, exudative and granulating base
Associated features of venous ulcer
Warm skin, normal peripheral pulses, leg oedema, haemosiderin and melanin deposition, lipodermatosclerosis, atrophie blanche
Possible investigations into venous ulcer
Normal ABPI
Management of venous ulcer
Compression bandaging after excluding arterial insufficiency
History of arterial ulcer
Painfu, especially at night and worse when legs evelated, history of arterial disease (atherosclerosis)
Common sites for arterial ulcers
Pressure and trauma sites such as pretibial, supremalleolar, and distal points
Presentation of arterial ulcer
Small, sharply defined, deep ulcer with necrotic base
Possible investigations into an arterial ulcer
ABPI is <0.8 from presence of arterial insufficiency. Doopler studies and angiography
Management of arterial ulcer
Vascular reconstruction
Associated features with an arterial ulcer
Cold skin, weak or absent peripheral pulses, shiny pale skin, loss of hair
History of neuropathic ulcer
Often painless, abnormal sensation, history of diabetes or neurological disease
Common sites for neuropathic ulcer
Pressure sites such as sole, heel, toes, metatarsal heads
Presentation of neuropathic ulcer
Variable size and depth, granulating base, may be surrounded by or underneath a hyperkeratotic lesion (callus)
Associations with a neuropathic ulcer
Warm skin, normal peripheral pulses, peripheral neuropathy
What is the difference if a neuropathic ulcer is an neuroischaemic ulcer
There are cold, weak or absent pulses
Possible investigations into neuropathic ulcer
ABPI <0.8 implies neuroischaemic ulcer, Xray to exclude osteomyelitis
