Leg Ulcers

Question 1

What is a chronic leg ulcer?

Answer 1

An open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks

Question 2

What are the causes of leg ulceration?

Answer 2

1. Venous insufficiency
2. Arterial insufficiency
3. Arterio-venous
4. Diabetic
5. Malignancy
6. Vasculitis
7. Inflammatory

Question 3

Venous leg ulcers and usually found in which specific area of the lower leg?

Answer 3

Gaiter area

Question 4

What are the characteristic of the leg in an arterial leg ulcer?

Answer 4

Hairless
Pale
Cold to touch
Unable to palpate pulses

Question 5

Describe a venous leg ulcer?

Answer 5

1. Superficial ulceration
2. Gaiter area
3. Signs of venous disease: varicosities, haemosiderin staining

Question 6

Describe an arterial leg ulcer?

Answer 6

1. Deep punched out
2. May be tendon exposure
3. Often on the foot/toes/pressure areas

Question 7

What investigation gives the ratio of the blood pressure at the ankle to the blood pressure in the upper arm?

Answer 7

ABPI (Ankle/brachial pressure index)

Question 8

What is a normal ABPI?

Answer 8

0.8 - 1.3

Question 9

What would an ABPI of < 0.8 suggest?

Answer 9

Vascular disease

Question 10

What would an ABPI of > 1.5 suggest?

Answer 10

Calcification

Question 11

Compression bandaging airmen to achieve what pressure at the ankle and just below the knee?

Answer 11

40mmHg at ankle

25mmHg below knee

Question 12

How often are compression bandages typically replaced?

Answer 12

Weekly

Question 13

Compression bandages are the treatment for which type of leg ulcer?

Answer 13

Venous

Question 14

What is the treatment for arterial leg ulcers?

Answer 14

Pain relief
Lifestyle changes - smoking
Aspirin
Treat infections
Soffban and crepe bandages toe to knee (reduce oedema)
Vascular surgery if indicated

Question 15

When should a patient with a leg ulcer be given a specialist referral?

Answer 15

1. If not improving after 12 weeks of optimum treatment
2. Atypical ulcer appearance
3. Suspect vasculitis
4. Inflammatory Ulcer
5. Malignancy
6. Peripheral vascular disease
7. If suspicion of contact allergy refer for patch testing

Question 16

What are the signs and symptoms of vasculitis?

Answer 16

Painful
Sudden onset
Necrotic
Purpuric rash

Question 17

Venous eczema (stasis dermatitis) occurs as a result of what?

Answer 17

Venous hypertension

Question 18

What are the symptoms of venous eczema?

Answer 18

Very itchy
Red
Scaly

Question 19

What is the presentation of a DVT?

Answer 19

Unilateral oedema
Pain
Tenderness
Warmth
Erythema