Limb Ulceration and Gangrene - Arterial and Venous Ulcers Flashcards Preview

CVS (Vascular Surgery) > Limb Ulceration and Gangrene - Arterial and Venous Ulcers > Flashcards

Flashcards in Limb Ulceration and Gangrene - Arterial and Venous Ulcers Deck (21)
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1
Q

What are leg ulcers?

A

Wounds or breaks in the skin that do not heal or heal slowly, due to underlying pathology. They have the potential to get progressively larger and become more difficult to deal with.

2
Q

What are the 4 commonest types of ulcers?

A
  1. Venous Ulcers (80%).
  2. Arterial Ulcers.
  3. Diabetic Foot Ulcers.
  4. Pressure Ulcers.
3
Q

What is a mixed ulcer?

A

A combination of arterial and venous disease causing the ulcer.

4
Q

What is Marjolin’s Ulcer?

A

A SCC that occurs at sites of chronic inflammation e.g. burns, osteomyelitis after 10-20 years that mainly occurs on the lower limb.

5
Q

What is Pyoderma Gangrenosum?

A

Erythematous nodules or pustules which ulcerate that can occur at stoma sites, associated with IBD and RA.

6
Q

Give 6 differences between Arterial and Venous Ulcers.

A
  1. SITE : A = Distally - Toes, Dorsum of Foot.
    V = Gaiter Area (between medial malleolus and bottom of calf).
  2. ASSOCIATIONS : A = PAD. V = Chronic Venous Insufficiency.
  3. SIZE : A = Smaller and Deeper. V = Larger and More Superficial.
  4. SHAPE : A = Well-defined borders and ‘punched-out appearance’. V = Irregular and gently sloping borders.
  5. SYMPTOMS : A = less likely to bleed but painful when flat or elevated leg. V = Less painful but relieved by elevated and more likely to bleed.
  6. EPIDEMIOLOGY - A = Elderly Men. V = Middle-Aged Women.
7
Q

What do arterial ulcers result from?

A

Insufficient blood supply to the skin due to PAD.

8
Q

What do venous ulcers result from? (2)

A
  1. Pooling of blood and waste products in the skin, secondary to chronic venous insufficiency (venous hypertension).
  2. Other causes : calf-pump dysfunction and neuromuscular disorders.
9
Q

Give 5 other features of chronic venous insufficiency.

A
  1. Oedema.
  2. Brown Hyperpigmentation (haemosiderin deposition).
  3. Liopdermatosclerosis.
  4. Eczema.
  5. Atrophic Blanche.
10
Q

Give 6 risk factors for venous ulcer disease.

A
  1. Obesity.
  2. Immobility.
  3. Varicose Veins.
  4. Previous DVTs.
  5. Age.
  6. Previous Trauma to Leg.
11
Q

Pathophysiology of Venous Ulcers (5).

A
  1. Valvular Incompetence/Venous Outflow Obstruction.
  2. Impaired Venous Return and trapping of WBCs in capillaries.
  3. Fibrin cuff around the vessel - hinders Oxygen transportation into tissue.
  4. WBCs activated with release of inflammatory mediators.
  5. Tissue injury, poor healing, necrosis.
12
Q

Investigations of Arterial/Venous Ulcers.

A
  1. ABPI (to either exclude or include PAD) always.

2. Arterial - ABPI/Doppler US. Venous - Clinical (after excluding arterial).

13
Q

Why is a Doppler Ultrasound useful?

A

Look for the presence of reflux.

14
Q

Why is a Duplex Ultrasound useful?

A

Anatomy and flow of the vein.

15
Q

Management of Arterial Ulcers.

A

Same as management of Peripheral Arterial Disease - urgent referral to vascular team to consider vascularisation.

16
Q

Management of Venous Ulcers.

A
  1. Lifestyle Advice.
  2. Emollient Treatment of Leg.
  3. Compression Bandaging.
  4. Pentoxifylline.
  5. Surgery (Debridement - Skin Grafting).
17
Q

What does good wound care of venous ulcers involve? (3)

A
  1. Cleaning wound.
  2. Debridement (removing dead tissue).
  3. Dressing the wound.
18
Q

Compression Bandaging (2).

A
  1. Treat venous ulcers after arterial disease is excluded.

2. 4 layers changed once or twice every week.

19
Q

What is Pentoxifylline?

A

Orally taken medication to improve healing (peripheral vasodilator) - not licensed.

20
Q

When is skin grafting required?

A

If the venous ulcer fails to heal after 12 weeks or it is larger than 10cm2.

21
Q

Complications of Venous Ulcers (4).

A
  1. Immobility (due to pain).
  2. Infection & Sepsis.
  3. Osteomyelitis.
  4. Decreased Quality of Life.