Leg Ulcers Flashcards
What is an ulcer?
Break in continuity of epithelium
Causes of ulcers in lower limb
Venous
Ischaemic
Neuropathic
Pressure
Infection
Malignancy
What is a venous ulcer?
Ulcer caused by venous insufficiency
Impaired venous return
‘Trapping’ of WBCs
Release of inflammatory markers
Tissue injury
Risk factors for venous ulcer
Increasing age
Venous incompetence
Pregnancy
Obesity
Clincal features of venous ulcers
Painful - aching pain
Skin tenderness
Lipodermatosclerosis
Found in gaiter region - over medial malleolus
Appearance of a venous ulcer
Shallow
Irregular border
Granulating base
Investigations for a suspected venous ulcer
Dupplex ultrasound - confirm venous insufficiency
ABPI - assess any arterial component
Swab cultures - if infection suspected
Management of venous ulcer
Leg elevation
Increase exercise - calf pump
Multicomponent compression bandaging
What is an arterial ulcer?
Ulcer caused by reduction in arterial blood flow
Decreased perfusion of the tissues so poor healing
Risk factors for arterial ulcers
Smoking
Hypertension
Hyperlipidaemia
Obesity
Clinical features of an arterial ulcer
Preceding history
- claudication
- critical limb ischaemia
Painful
Cold limbs
Absent pulses
Occur distally
Sites of trauma
Pressure areas
Appearance of an arterial ulcer
Small deep lesion
Well defined border
Necrotic base
Investigations for a suspected arterial ulcer
ABPI
Management of an arterial ulcer
Vascular review
Conservative
- smoking cessation
- weight loss
Medical
- statin
- antiplatelet
- blood pressure management
Surgical
- angiolasty
- bypass grafting
What is a neuropathic ulcer?
Ulcer that occurs as a result of peripheral neuropathy
Loss of protective sensation, repetitive stress and unnoticed injuries on pressure areas
