Venous ulcers Flashcards
Define venous ulcers
Large, shallow, sometimes painful ulcers usually found superior to the medial malleoli.
They are caused by incompetent valves in the lower limbs leading to venous stasis and ulceration.
Explain the aetiology/risk factors of venous ulcers
They are caused by incompetent valves in the lower limbs. Valve incompetence leads to venous stasis and increased venous pressure. This results in ulceration
Risk Factors Obesity Immobility Recurrent DVT Varicose veins Previous injury/surgery to the leg Age
Summarise the epidemiology of venous ulcers
VERY COMMON
Increases with age
Recognise the presenting symptoms of venous ulcers
Large, shallow, relatively painless ulcer with an irregular margin situated above the medial malleoli (mostly)
Features of the history: Varicose veins DVT Phlebitis Fracture, trauma or surgery Family history
Other symptoms of venous insufficiency:
Swelling
Itching
Aching
Recognise the signs of venous ulcers on physical examination
Described above
Other signs of venous ulcers: Stasis eczema Lipodermatosclerosis (inverted champagne bottle sign if SEVERE) Haemosiderin deposition (dark colour)
Identify appropriate investigations for venous ulcers
ABPI - Exclude arterial ulcer
If ABPI < 0.8 - do NOT apply a pressure bandage as this could worsen the ulcer
Measure surface area of ulcer - allows monitoring of progression
Swabs for microbiology - if signs of infection
Biopsy - if possibility of Marjolin’s ulcer
Generate a management plan for venous ulcers
Graduated compression (reduced venous stasis)
NOTE: must exclude diabetes, neuropathy and PVD before this is attempted
Debridement and cleaning
Antibiotics - if infected
Topical steroids - may help with surrounding dermatitis
Identify possible complications of venous ulcers
Recurrence
Infection
Summarise the prognosis for patients with venous ulcers
GOOD
Results are better if patients are mobile with few comorbidities
