Why do arterial ulcers occur- physiology
Due to poor blood supply to the skin due to peripheral arterial disease
Why do venous ulcers occur-
physiology
Pooling of blood and waste products in the skin secondary to venous deficiency (varicose veins, DVT, phebilitis- inflammation of the vein)
Mixed ulcers- what are they
Combination of arterial and venous ulcers
Distinguishing features of arterial ulcers
- Absent pulses
- Pallor
- Tend to be smaller
- More regular border
- Grey colour due to poor blood supply
- Less likely to bleed
- More painful than venous ulcers
- Pain at night when legs elevated
- Pain worse on elevating the leg- improved by hanging
Venous ulcers distinguishing features
- Oedematous flushed skin
- Hyperpigmentation to skin
- Varixose eczema
- tend to larger
- Irregular border
- More likely to blled
- Pain relieved by elevation and worse on hanging
Management of ulcers (general)
Treat underlying cause
Would care- debridement, cleaning, dressing, antibiotics where infected
Arterial ulcers location
- End of toes
- Top of feet (dorsum)
- Lateral ankle region (malleolus)
Appearance of arterial ulcers
- Very little drainage
- Little tissue granulation- pale pink or necrotic black
- Deep punched out appearance with noticeable margins/edges
Appearance of venous ulcers
- Medial parts of lower legs
- Medial ankle region
- Swollen with drainage
- Granulation present- pink to red
- Edges irregular
- Shallow
Position to help alleviate pain of arterial ulcers
Dangling legs down - elevation makes pain WORSE
Position to help alleviate pain of venous ulcers
Elevation of legs- decreases swelling and helps with blood flow
Dangling legs or standing for long periods makes pain and edema worse
Arterial ulcer pain
- Sharp- worst at night
Intermittent claudication - Activity causes severe pain in the calf muscle, thighs, buttocks
Venous ulcer pain
Heavy, dull, throbbing, achy
Pain worst when standing or sitting
- Elevating legs easer pain
Skin changes in arterial ulcers
- Cool to touch
- Thin, dry, scaly skin
- Hairless
- Thick toenails
Skin changes in venous ulcers
- Warm to touch
- Thick, tough skin
- Brownish colour
Pulses in arterial ulcers
Very poor/absent
Pulses in venous ulcers
Present, typically normal
In which type of ulcer is oedema present?
Venous
Name for area in the leg where venous ulcers occur
Gaiter’s area
Link between venous hypertension and venous ulcers
Ulcers as a result of venous hypertension in the superficial vein due to incompetent valves in the deep/perforating veins or previous DVT
- Increases pressure leads to extravastion of fibrinogen through capillary walls
Causes of venous ulcers
Venous hypertension
- Arterial disease
- Neuropathic
- Neoplastic
- Vasculitis
- Infection
- Haematological
- Drugs-
Management of venous ulcers
High-compression bandaging- 4 layer bandaging and leg elevation due to reduced venous hypertension
- Diuretics to help ease the swelling
- Doppler scan
Management of arterial ulcers
Keep the ulcer clean and remove pressure or trauma from the affected area
Buerger’s disease- what is it
Buerger’s disease (also known as thromboangiitis obliterans) is a small and medium vessel vasculitis that is strongly associated with smoking.
