Arterial & Venous Ulcers

Question 1

What re the 4 common types of leg ulcers?

Answer 1

1) Venous
2) Arterial
3) Diabetic foot ulcers
4) Pressure ulcers

Question 2

What do arterial ulcers result from?

Answer 2

Insufficient blood supply to the skin due to PAD.

Question 3

What do venous ulcers result from?

Answer 3

Pooling of blood and waste products in the skin 2ary to venous insufficiency.

Question 4

What are mixed ulcers?

Answer 4

A combo of arterial & venous disease causing the ulcer.

Question 5

Location of arterial vs venous ulcers?

Answer 5

Arterial –> toes or dorsum of foot or heel

Venous –> gaiter area (between the top of the foot and bottom of the calf muscle), often above ankle

Question 6

Pain in arterial vs venous ulcers?

Answer 6

Arterial - very painful

Venous - often painless

Question 7

Depth of arterial vs venous ulcers?

Answer 7

Arterial - deeper, have a ‘punched out’ appearance

Venous - more superficial

Question 8

Size of arterial vs venous ulcers?

Answer 8

Arterial - smaller

Venous - larger

Question 9

Borders of arterial vs venous ulcers?

Answer 9

Arterial - well defined borders

Venous - irregular, gently sloping border

Question 10

What are arterial ulcers associated with?

Answer 10

Are associated with PAD, with absent pulses, pallor and intermittent claudication

Question 11

What are venous ulcers associated with?

Answer 11

Are associated with chronic venous changes, such as hyperpigmentation, venous eczema and lipodermatosclerosis

Question 12

Are venous or arterial ulcers more likely to bleed?

Answer 12

Venous

Question 13

How is pain worsened/improved in arterial ulcers?

Answer 13

Worse - on elevating

Improved - lowering leg (gravity helps the circulation)

Question 14

How is pain worsened/improved in venous ulcers?

Answer 14

Worse - lowering leg

Improved - elevating leg

Question 15

What investigation is used to assess for arterial disease?

Answer 15

Ankle-brachial pressure index (ABPI)

Question 16

Mx of arterial ulcers?

Answer 16

Same as PAD –> urgent referral to vascular to consider surgical revascularisation.

Question 17

Is debridement and compression used in arterial ulcers?

Answer 17

No

Question 18

Mx of venous ulcers?

Answer 18

1) Tissue viability / specialist leg ulcer clinics in complex or non-healing ulcers:
- Cleaning the wound
- Debridement (removing dead tissue)
- Dressing the wound

2) Compression therapy (after arterial disease is excluded with an ABPI)

3) Pentoxifylline (taken orally) can improve healing in venous ulcers

4) Abx for infection

5) Analgesia

Question 19

What analgesia should be avoided in venous ulcers?

Answer 19

NSAIDs (worsen condition)

Question 20

What is Marjolin’s ulcer?

Answer 20

Squamous cell carcinoma occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years

Mainly occur on the lower limb