Leg Ulcers

Question 1

what is a chronic leg ulcer?

Answer 1

open wound between knee and ankle that remains unhealed for more than 4 weeks

Question 2

what are the most common type of leg ulcer?

Answer 2

venous > arterial > rheumatoid arthritis > diabetic (neuropathy) > mixed

Question 3

who are leg ulcers common in?

Answer 3

IV drug users
elderly
diabetics
cardiovascular patients

Question 4

are leg ulcers usually treated in or out of hospital?

Answer 4

usually in the community

Question 5

what contributes to the cost of venous leg ulcers?

Answer 5

delay in assessment, diagnosis and ABPI measurements

delays in commencing compression or confidence in applying compression bandages

Question 6

what else can cause similar symptoms to a leg ulcer?

Answer 6

vasculitis - vasculitic rash
malignancy
inflammation

Question 7

order of assessment of a leg ulcer?

Answer 7

patient
leg
ulcer

Question 8

relevant history for leg ulcers?

Answer 8

steroids
smoking status
mobility
nutrition
cardio disease
home help
extent of pain

Question 9

how can lack of mobility cause a leg ulcer?

Answer 9

muscle pump not in use so not pumping blood back up the leg causing it to leak out

Question 10

are there any muscles in veins?

Answer 10

no

therefore varicose veins can develop if immobile etc as well as blood leaking out of vessels

Question 11

what is lipodermatosclerosis?

Answer 11

woody, tethered, sclerotic skin in relation to venous hypertension?

Question 12

what is venous dermatitis?

Answer 12

eczema secondary to venous hypertension

scaling around the ankle and visible veins in foot

Question 13

where are each type of ulcer ulcers most common?

Answer 13

venous = gaiter area (highest pressure)
heel common place for pressure ulcer
toes = diabetic neuropathy

Question 14

what is slough?

Answer 14

debris

dead skin cells, bacteria and exudate which can slow down healing

Question 15

what does an arterial ulcer look like?

Answer 15

pale, hairless leg
sharp, punched out lesion
deeper
unusual/ulcerated toe region

Question 16

what can mimic a leg ulcer?

Answer 16

necrobiosis lipoidoca

Question 17

what commonly causes vasculitis?

Answer 17

antibiotics

also results in widespread rash

Question 18

normal ABPI?

Answer 18

around 1
< 0.8 = vascular disease
>1.5 = calcification
0.8-1.3 = needs compression

Question 19

what can a venous ulcer be confused with?

Answer 19

BCC

if not healing with compression - think it might not be an ulcer

Question 20

how are ulcers investigated?

Answer 20

APBI
only swab if strong evidence of infection
Bloods (FBC, LFTs, U&Es, CRP)
patch testing if they also have bad eczema as treatment could be causing it
Duplex if needed

Question 21

how are venous ulcers treated?

Answer 21

pain control
ABPI
Non-adherent dressing
de - sloughing (hydrogel, honey etc)
4 layer compression bandaging
leg elevation (above hip height)

Question 22

when are compression stockings used?

Answer 22

if small ulcer

after ulcer has healed as prophylaxis

Question 23

how quickly are ulcers aimed to be healed?

Answer 23

by 12 weeks

Question 24

how is slough removed?

Answer 24

honey, hydrogels

Question 25

how can a wound site be cleaned/prepared/dead skin removed etc?

Answer 25

autolytic - dressings etc
sharp debridement - scalpel/scissors
biological - maggots
surgical - removal of dead tissue under GA

Question 26

why is zinc paste used in maggot treatment?

Answer 26

to protect surrounding skin from exudate caused

Question 27

why is zinc paste used in maggot treatment?

Answer 27

to protect surrounding skin from exudate caused

Question 28

which dressings heal ulcers?

Answer 28

none

compression heals ulcers

Question 29

how should leg ulcers be washed?

Answer 29

warm tap water and soap substitute

because the wound isn’t sterile

Question 30

how is venous dermatitis managed?

Answer 30

emollients
patch testing
topical steroids
compression

Question 31

name 3 relevant diseases in management of leg ulcers

Answer 31

cardiovascular disease
diabetes
DVT

Question 32

what shape is aimed for when padding and bandaging a leg

Answer 32

cone

Question 33

how long do compression stocking last before they must be changed?

Answer 33

6 months

Question 34

what is pyoderma gangrenosum?

Answer 34

autoinflammatory disorder causing al large ulcer

Question 35

what are the signs and symptoms of vasculitis?

Answer 35

inflammation of blood vessels causing purpuric rash/pustules
sudden and painful
necrotic