Clinical: Leg Ulcers Flashcards
What is the definition of leg ulceration?
Complete epidermal loss, thus exposing the dermal layers
Name the 4 underlying pathologies that can result in leg ulceration?
-Venous disease -Arterial disease -Vasculitis -Neuropathy
What else may be present alongside leg ulceration?
Varicose veins
What are the predisposing factors for varicose veins?
DVT and obesity
What is the first symptom of venous ulceration?
Heaviness of the legs, followed by oedema
What is the progression of leg ulceration?
1) Heaviness of the legs, followed by oedema 2) Haemosiderin pigmentation, pallor and firmness of surrounding area 3) Lipodermatosclerosis (inflammation of the layer of fat below the epidermis)- fibrosis of dermis and subcutis
Label these areas of leg ulceration according to:
Venous, Arterial, Vascular and Neuropathic
Venous: light blue
Red: Vascular
Purple: Arterial
Orange: Neuropathic
What is the underlying cause of this venous ulceration: “deep, painful, punched-out ulcers on the lower leg”?
Arterial disease
What are the risk factors of ulceration due to arterial disease?
-Smoking, hypertension, diabetes and hyperlidaemia
How can vasculitis cause leg ulceration?
Directly through epidermal necrosis due to damage to the underlying vasculature, or indirectly due to neuropathy
What are the most common causes of neuropathic ulceration?
Diabetes and Hansen’s disease as well as microangiopathy in diabetes.
Where are the most commonly affected areas of leg ulceration due to neuropathy?
Weight-bearing areas such as the heel
When should compression bandaging be used?
For individuals with an ABPI>0.8 but not less!
In terms of ABPI for leg ulcers, what do they following readings translate as?
a) 0.8-1.3
b) <0.8
c) >1.5
a) normal
b) Vascular disease
c) Calcification
What is the difference in appearance between venous and arterial leg ulcers?
Venous:Shallow edge “like a beach”
Arterial:Very sharp, cliff like edges and can be described as “punched out”
What is the definition of a leg ulcer?
Any break in the skin above the ankle for more than 4 weeks
