Leg Ulcers Flashcards
(12 cards)
Outline the three major types of leg ulcers?
Venous
Neuropathic
Arterial
What is the process that leads to the formation of a venous ulcer?
Venous insufficiency occurs when there is failure of the valves to prevent back flow of venous blood.
Stasis and back flow of blood causes an increase in venous pressure
This causes compression small capillaries leading to ischaemia and the formation of an ulcer
What are some risk factors for venous ulcers?
Female Increasing age Pregnancy Obese Standing for prolonged periods of time
Describe the features of venous ulcers?
Found in the gaiter area- mid calf to ankle Shallow and irregular borders Mild to moderate pain Yellow fibrinous exudate Associated skin changes Oedema man and varicose veins visible
What are the skin changes seen in venous insufficiency?
Lipodermatosclerosis Haemosiderin deposition Status dermatitis Venous eczema/dermatitis Atrophie blanch
Why might legs appear dark brown in venous insufficiency?
Due to haemosiderin deposition- this is a by product of the breakdown of red blood cells
What is lipodermatosclerosis?
Inflammatory condition that occurs due to venous insufficiency where there is subcutaneous fibrosis and hardening of the skin on the lower legs
Features include induration, erythema, pain, itching, upside down champagne bottle appearance due to subcutaneous fibrosis causing narrowing, haemosiderin deposition and atrophie blanch (white depressed plaques)
Outline the deep venous drainage of the lower limb
Superficial and deep system
Deep-
Arcuate vein drains into the Anterior Tibial Vein
Deep plantar venous arch drains to medial and lateral plantar vein drain into the posterior tibial vein
Posterior and Anterior Tibial Vein Both drain to the Popliteal Vein. Note peroneal vein drains into posterior tibial artery.
Popliteal Vein becomes the Femoral Vein
Profunda femoris vein drains to the femoral vein
Once crosses the inguinal ligament it becomes the external iliac vein
External iliac vein joins the internal iliac vein to become the common iliac vein.
Common iliac veins join to form the the IVC at L5 spinal level
Outline the superficial venous drainage system of the lower limb
Great saphenous vein runs along the medial aspect of the leg. Arises from the medial dorsal arch. Drains into the deep system at the femoral vein.
Small saphenous vein rules along the lateral aspect of the lower leg. Arises from lateral aspect of dorsal venous arch. Drains into the popliteal vein at the level of the knee.
What are perforating veins?
These are small veins which run from the superficial to the deep system.
Outline the features of arterial ulcers?
Sharp borders Painful Punched out appearance Often over pressure points Dry Associated hair loss, diminished foot pulses, shiny skin
How can a neuropathic ulcer be differentiated from an arterial ulcer?
Arterial ulcers are painful
Neuropathic ulcers are not painful and there will be decreased sensation around the ulcer. Associated with a long standing history of diabetes and neuropathy elsewhere.
