Arterial vs. Venous Ulcers

Question 1

Arterial Ulcer:

Etiology:

Appearance:

Location:

Pedal Pulses:

Pain:

Drainage:

Assoc Gangrene:

Assoc Signs:

Answer 1

• Etiology:
  
  • atherosclerosis or atheroembolism
• Appearance:
  
  • irregular, smooth edges, min granulation, usually deep
• Location:
  
  • distal lower leg
  • LATERAL malleolus
  • anterior tibial area
• Pedal Pulses:
  
  • decreased or absent
• Pain:
  
  • very, p! inc w/ legs raised
• Drainage:
  
  • not present
• Assoc Gangrene:
  
  • maybe
• Assoc Signs:
  
  • trophic changes
  • pallor w/ foot elevation
  • dusky rubor on dependency

Question 2

Arterial Insuffiency Ulcers

Treatment

Answer 2

• Treatment
  
  • bed rest w/ HOB elevated mod
  • stopping of smoking
  • wound care
  • ROM
  • protective environment
  • wound vac may be useful
  • if ABI <!--= 0.5 wound will not heal without medical intervention </li-->

Question 3

Venous Insufficiency Ulcers

Treatment

Answer 3

• Treatment
  
  • elevation and compression to control edema is vital (unna boot, custom elastic stockings and intermitt. compression therapy)
  • whirlpool not helpful due to dependent position
  • active exercise w/ support garments
  • compression stockings are necessary for long term management

Question 4

Venous Ulcers

Etiology:

Appearance:

Location:

Pedal Pulses:

Pain:

Drainage:

Assoc Gangrene:

Assoc Signs:

Answer 4

• Etiology:
  
  • valvular incompetance, venous HTN
• Appearance:
  
  • irregular, dark pigmentation, sometimes fibrotic, good granulation, shallow
• Location:
  
  • distal lower leg
  • MEDIAL malleolus
• Pedal Pulses:
  
  • present
• Pain:
  
  • little p! comfortable w/ legs elevated
• Drainage:
  
  • moderate to large exudate
• Assoc Gangrene:
  
  • absent
• Assoc Signs:
  
  • edema
  • stasis dermatitis
  • possible cyanosis on dependency

Question 5

Diabetic Foot Ulcers

Etiology and Treatment

Answer 5

• Characteristics
  
  • PVD and neuropathy
  • autonomic neuropathy
  • decreased sensation/circulation
  • Charco Foot (later stages)
  • staging with Wagner Scale
  • dry inelastic shiny skin
• Treatment
  
  • standard ulcer management
  • debride necrotic tissue
  • promote moist wound healing
  • offload ulcer from abnormal pressure
    
    • total contact case or change WB
    • contra-indicated if infected or depth > width
  • shoe modification: rocker bottom soul