Leg Ulcers Flashcards
Define a leg ulcer
Open lesion between the knee and ankle joint which remains unhealed for at least 4 weeks
Are ulcers more commonly venous or arterial?
Venous
Outline the pathogenesis of venous ulcer development
Venous insufficiency > venous stasis/pooling > venous hypertension and distension > oedema and leaky capillaries > cuff formation around vessels > ischaemia > necrosis
Give some causes of venous ulceration
DVT
Varicose veins
Fractures
Surgery
Give some causes of arterial ulceration
Same as all arterial disease really Smoking PVD IHD stroke
What are other important cause of ulcers to rule out?
Diabetes
Vasculitis
How do venous ulcers present?
Ulcers with varicose veins, oedema, haemosiderin staining, lipodermatosclerosis, atrophie blanche, itch
What is atrophie blanche?
White scar like areas seen in advanced venous disease (usually precedes ulcer)
What is lipodermatosclerosis?
Hardening and fibrosis of the skin in the lower leg
How do arterial ulcers appear?
Pale, cold, reduced/absent pulses, delayed cap refill, loss of hair
On which part of the leg do arterial ulcers present?
Pressure points
Point of trauma
How do vasculitic ulcers present?
Polymorphic, bilateral lesions
May necrose or coalesce
Basically like a vasculitic rash
What is the most important investigation for ulcers?
ABPI
What is the management of venous ulceration?
Compression bandaging is best
Also venous surgery; pentoxifyline if no responset to compression; hyperbaric oxygen therapy; larval debridement
What is Marjolin’s ulcer?
Malignant change of an ulcer to a squamous cell carcinoma
What prophylaxis can be used for ulcers?
Compression stockings replaced every 4-6 weeks
