Clinical anatomy of Venous Ulceration Flashcards
What are some regions of the upper limb?
Axilla, arm (brachium), elbow/cubital fossa, forearm (ante-brachium), wrist, hand
What parts of the body does the axilla connect?
The upper arm and the trunk
What are some regions of the lower limb?
Inguinal region/groin, thigh, knee/popliteal fossa, leg, ankle, foot
What parts of the body does the groin connect?
The lower limb and the trunk
What does each limb require?
Arterial supply, venous drainage and lymphatic supply
What does the subclavian artery pass under?
The clavicle
Where does the deep brachial artery bifurcate?
In the cubital fossa
What is the direction of arterial blood flow in the arm?
Subclavian artery, axillary artery, brachial artery, deep brachial artery, ulnar artery + radial artery, deep and superficial palmar arches, metacarpal and digital arteries
Where does the popliteal artery bifurcate?
Within the popliteal fossa
What is the other name for the acuate artery?
Dorsal arch
What is the direction of arterial blood flow in the leg?
External iliac artery, deep femoral artery, perforators, femoral artery, popliteal artery, anterior + posterior tibial arteries, dorsalis pedis + medial and lateral plantar arteries, acuate artery + deep plantar arch, metatarsal and digital arteries
How do you limit blood loss to an injury?
Apply pressure proximal to site of injury-press on pulse point and apply tourniquet
Where in the neck is the bifurcation of the common carotid artery?
Anterior to sternocleidomastoid muscle at the level of the upper border of thyroid cartilage
Where can the brachial artery pulse be found?
Medial to biceps tendon in the cubital fossa
Where can the radial artery pulse be found?
Lateral to the tendon of flexor carpi radialis
Where is the femoral artery pulse located?
Inferior to the midpoint of inguinal ligament
Where is the popliteal artery pulse found?
In the popliteal fossa (immediately behind the knee)
Where is the posterior tibial artery pulse located?
Between the posterior border of the medial malleolus and the achilles tendon
Where can the dorsalis pedis artery pulse point be palpated?
Medial to the tendon of extensor hallucis longus distal to the ankle joint
What is ischaemia?
Inadequate oxygenation of cells/tissues/organs due to an interruption to blood supply
What are some causes of reduced arterial perfusion pressure?
Left ventricular failure, arterial bleed, arterial rupture (aneurysm), occlusion of lumen, arterial spasm, external compression of arterial supply
What are some causes of increased venous drainage pressure?
Right/congestive heart failure, DVT, external compression
What are some features of superficial veins?
Smaller, thinner, run in superficial fascia, highly variable, drain into deep veins
What are some features of deep veins?
Larger, thicker, run into deep fascia, more predictable, often occur in neurovascular bundles
What is another name for superficial fascia?
Subcutaneous tissue
What are some features of superficial fascia?
Loose connective tissue and fat, varies in depth, superficial blood vessels, cutaneous nerves, lymphatics and sweat glands
What are some features of deep fascia?
Relatively tough and sheet like, dense connective tissue, usually white (glistening), named
What does deep fascia divide the limbs into?
Compartments
What does deep fascia cover?
Most of the body deep to the skin and superficial fascia
What does deep fascia form when it invests muscles?
Intramuscular septa
What are some superficial veins of the upper limb?
Cephalic vein and Basilic vein
What does the cephalic vein arise from and where is it found?
Arises from the dorsal venous network; found at the lateral aspect of limb in the deltopectoral groove
What does the cephalic vein drain into?
The axillary vein
Where does the cephalic vein become the subclavian vein?
At the lateral border of rib 1
What does the basilic vein arise from and where is it found?
Arises from the dorsal venous network; found on medial aspect of limb
What does the basilic vein drain into?
Brachial vein at level of mid-arm
What are some superficial veins of the lower limbs?
Great saphenous vein and small saphenous vein
Where is the great saphenous vein and where does it arise from?
Found on medial aspect of limb; arises from dorsal venous arch
What does the great saphenous vein drain into?
The femoral vein at the femoral triangle
Where does the small saphenous vein arise from?
The dorsal venous arch
Where can the small saphenous vein be found and where does it drain into?
Found on the posterior midline of limb; drains into popliteal vein posterior to knee
What are the only two veins which aren’t bilateral?
The SVC and the IVC
What does Vena comitantes mean?
Accompanying vein-the vein surrounds an artery
How does surrounding an artery benefit the vena comitantes?
Benefits from the pulsation of the artery when enclosed within a vascular sheath
What is the function of venous valves?
Ensure unidirectional blood flow against gravity
What can incompetent valves cause?
Reverse flow into superficial veins, causing weak and dilated varicose veins
What is the direction of venous blood flow?
Superficial vein, perforating veins, deep veins
What does the musculovenous pump do?
Pushes blood back towards the heart
How does venous ulceration arise?
Venous pressure increases, damages blood vessels in skin, skin becomes dry/itchy/inflamed, can’t heal well due to poor blood supply so begins to break down
How can a DVT arise?
Due to venous stenosis
What can happen if a thrombus breaks off?
It can occlude the vessel and cause an infarction
What happens if a thrombus becomes lodged in the pulmonary artery?
Infarction of one lung
What happens if a thrombus becomes lodged in the pulmonary trunk?
Complete occlusion by a saddle embolus arrests the circulation
What do lymphatics generally follow?
Veins
Where do the superficial lymphatics of the upper limb arise?
Arise from the plexus in fingers and hand
What is the direction of flow in the superficial lymphatics that follow the basilic vein in the arm?
Basilic, cubital lymph nodes, lateral axillary lymph nodes
Where do the superficial lymphatics that follow the cephalic vein in the upper arm drain into?
Mainly to apical axillary lymph nodes
Where do the deep lymphatics of the upper arm drain into?
Lateral axillary lymph nodes
What is the direction of flow of the superficial lymphatics of the lower limbs that follow the great saphenous vein?
Great saphenous vein, superficial inguinal nodes, external iliac nodes or deep inguinal nodes
What is the direction of flow of the superficial lymphatics of the lower limbs that follow the small saphenous vein?
Small saphenous vein, popliteal nodes, deep inguinal nodes, external iliac nodes
What veins do the superficial lymphatics of the lower limb follow?
The saphenous veins
What veins do the deep lymphatics of the lower limbs follow?
The deep veins
What is the direction of flow of the deep lymphatics of the lower limb?
Drain into popliteal lymph nodes, then deep inguinal nodes and into the external iliac nodes
Where do the external iliac nodes of the lower limbs drain into?
Drain into the common iliac nodes and enter the lumbar lymphatics
What is the elliptical incision used for?
Removing small skin lesions
What are some complications of elliptical incisions?
Nerve injury, bleeding from superficial veins
How should elliptical incisions be closed?
Using several simple interrupted sutures
What kind of arteries are Digital arteries?
End arteries-only blood supply to an area
Where is the most common area for venous ulceration?
The medial aspect of the distal thigh (known as the gaiter area)
