Arterial Ulcers

Question 1

Define arterial Ulcer and RF

Answer 1

Ulcer is defined as a full thickness break down of the skin
Arterial Ulcers are due to insufficient blood supply

can be acute, recurrent or chronic

tends to be on Lower limbs

Most often the ulcer will develop following a small wound that failed to heal because of bad blood supply

Causes of bad blood supply:
T2DM, Hypercholestermia, smoking, HTN, Renal failure, RA, Obesity
Other clotting issues

Question 2

Symptoms of arterial ulcer

Answer 2

Hx is a big clue for risk factors-vasculopath

Toes and Heels-pressure area
Painful, especially at night
symmetrical and good edges-punched out
Cool, pale or Blue , gangrene
surrounding skin
Loss of surrounding hairs
absent ankle pulse

can present as:
Intermittent claudication (leg/butt cramping relieved when relaxing)
Burning leg/foot at rest, worse when lowered,

capilary refill time-arterial insufficiency
Bueger test-legs/feel are pale when lifted and very red when lowered
Ankle Brachial Pressure Index (ABPI)-<0.7
doppler of the leg

Question 3

investigations for arterial Ulcers

Answer 3

capilary refill time-long-arterial insufficiency

Bueger test-legs/feel are pale when lifted and very red when lowered

Ankle Brachial Pressure Index (ABPI)-<0.9
doppler of the leg

Other differential- Pressure sore, skin cancer, vasculitis

Question 4

management of arterial ulcer

Answer 4

Restore some blood flow to the area–Angioplasty is the surgery of choice

Also dressings- not compression stocking ever