Clinical Symposium 10: Chronic Leg Ulcer Flashcards
Define Ulcer
a local defect or excavation of the surface of an organ or tissue that is produced by sloughing of inflammatory necrotic tissue
Define Erosion?
loss of an area of epidermis
What is the most common leg ulcer?
Venous
Other than venous and arterial leg ulcers, give 6 other causes of leg ulcers: (7)
1) peripheral neuropathy
2) inflammation
3) cancer
4) vasculitis
5) infection
6) diabetes
7) trauma
Give 3 risk factors for venous leg ulcers:
1) vascular incompetence
2) previous damage to the venous system (e.g. DVT, hypertension)
3) obesity and immobility (poor muscle contraction causing venous pooling)
How do venous complications often lead to ulceration?
high pressures in the veins of the legs makes healing difficult after a minor injury
Where are venous leg ulcers most commonly located?
medial gaiter area (mid-shin)
Which is generally more painful - arterial or venous leg ulcers?
Arterial
Describe the appearance of venous leg ulcers:
superficial and sloughy with ill defined boarders
Give 5 presentations associated with chronic venous hypertension:
1) varicose veins
2) lipodermatosclerosis
3) venous flare
4) atrophie blanche
5) varicose eczema
What is venous flare?
an allergic response to an irritant cause thin, spindly veins on the ankle and calf
What is atrophie blanche?
circular whitish skin due to delayed healing
What is the primary underlying cause of arterial leg ulcers?
peripheral vascular disease (plaques limiting oxygenated blood in the lower limbs)
Give 8 risk factors for leg ulcers:
1) obesity
2) renal failure
3) diabetes
4) smoking
5) high blood pressure
6) history of ischaemic heart disease
7) clotting and circulation disorders
8) rheumatoid arthritis
Where are arterial ulcers usually found?
lower leg and foot
Describe the surrounding skin of an arterial ulcer:
dry, cool, pale and hairless
Describe how Buerger’s sign can check for peripheral vascular disease and poor circulation in the lower limbs:
pallor results if a leg is raised
What is a neuropathic ulcer?
An ulceration as a result of peripheral neuropathy
What is peripheral neuropathy?
Weakness, numbness, and pain from nerve damage
Where are neuropathic ulcers commonly found?
on the sole of the foot
Give two causes of peripheral neuropathy:
1) diabetes
2) alcohol B1/B12 deficiency
What are ‘initial pustule ulcers’?
pustules that form ulcers
Describe the appearance of initial pustule ulcers:
dark red base with overhanging purple/ bluish boarders
True or false: initial pustule ulcers can spread rapidly
true
Describe the appearance of malignancy ulcers:
they have rolled edges
True or false: pyoderma gangrenosum ulcers have no association with gangrene or pus
true
What are pyoderma gangrenosum ulcers?
inflammatory ulcers with no cause identified but are associated with inflammatory bowel disease and rheumatoid arthritis
Give two drugs used to treat pyoderma gangrenosum ulcers:
1) prednisolone
2) ciclosporin
What is would are healed by second intention?
wounds with tissue loss or wounds with margins not apposed
Describe the steps of healing by second intention: (3)
1) granulation tissue is laid
2) organisation follows (layering of scar tissue)
3) epithelial regeneration
What are the 3 steps used to manage and treat leg ulcers:
1) treat underlying cause
2) treat the ulcer
3) treat any associated infection
Give an example of a drug used to treat venous leg ulcers:
pentoxifylline
What type of drug is pentoxifylline?
methylxanthine
How does pentoxifylline treat venous ulcers?
it increases microvascular blood flow to enhance oxygenation of ischaemic tissue and aid healing
What item of clothing can be worn to increase arteriole blood pressure in the legs?
compression stockings
