arterial ulcers Flashcards
definition of arterial ulcers
skin defect due to impaired blood flow to the lower extremities
aetiology of arterial ulcers
RF:
- coronary heart disease
- history of stroke or TIA
- dm
- peripheral arterial disease including intermittent claudication
- obesity and immobility
epidemiology of arterial ulcers
22% of leg ulcers
sx of arterial ulcers
punched out ulcer with well defined borders
Usually involves the foot, particularly pressure points (e.g., lateral malleolus, tips of the toes)
Often severe pain, particularly at night, relieved by dependency
distal or on dorsum of foot/toes over bony prominences
Initially they have irregular edges but this may become more clearly defined.
Nocturnal pain is typical. It is worse when supine and is relieved by dangling the legs out of bed.
signs of arterial ulcers
if arterial compromise, such as pallor, loss of hair, nail dystrophy, coldness, and diminished capillary refill, wasting of calf muscles
A history of intermittent claudication, cardiovascular disease, or stroke may indicate the presence of arterial disease
poor greyish, granulation tissue
dry necrotic base
debriding these ulcers, produces little or no blood.
Ix for arterial ulcers
check urine for glucose - unless known dm
in dm - check records for dm care and level of control
swabs if suggestion of active infection - increased pain, enlarging ulcer, cellulitis, pyrexia
blood tests - FBC, ESR, UE, creatinine, autoAB, haemoglobinopathy
patch testing
ABPI with handheld doppler
angiography to assess viability of tissue if plastic surgery/revascularisation is considered
CT
Intravascular ultrasound can be used to determine plaque volume within the wall of an artery and/or the degree of stenosis. It can also discriminate between normal and diseased components
interpretation of ABPI
1 = normal
Graduated compression bandages may be applied if the figure is 0.8 or higher.
between 0.5 and 0.8 suggests arterial disease and requires referral to a vascular clinic for further assessment.
ABPI less than 0.5 suggests arterial ulcers
ABPI measurements in patients with diabetes or atherosclerosis may be falsely high and misleading. Calcification of the vessels causes rigidity and artificially high readings.
mx of arterial ulcer
lifestyle - smoking, BP, cholesterol, HbA1c
wound care:
* clean and moist - change dressing
* debridement
rx wound infection if clinical signs (swollen, hot, red, pain, increase sixe, discharge, fever)
surgery
* skin graft/flap
* revascularisation with bypass/angioplasty - improve healing of ulcer by restoring oxygen and nutrient supply to tissue
