Leg Ulcer Management Flashcards
Compression therapy is the mainstay of venous ulcer treatment.
T
Bacterial colonisation of chronic wounds always adversely affects healing.
F
Moist wound healing is better than dry wound healing.
T
Venous insufficiency is the most common cause of leg ulcers.
T
Up to 50% of patients with chronic venous insufficiency have a history of leg injury.
T
Venous ulcers that are not complicated by infection typically have minimal exudate.
F Exude copious exudates – yellowish fibrinopurulent, irregularly-shaped adherent exudates may be seen at the base of the ulcer
Risk factors for arterial ulcers include diabetes, smoking, hyperlipidaemia, hypertension, obesity and age.
T
Venous ulcers will often be associated with hair loss, atrophy, cold surrounding skin, and thickened toenails.
F Arterial ulcers.
Capillary refill time in the setting of venous ulcers is usually prolonged.
F Arterial ulcers,
Immobility is necessary for pressure ulcer development
T
Impaired nutritional states along with low albumin and immobility can lead to epidermal moisture and vapour loss which leads to breakdown of the stratum corneum barrier
T
Arterial ulcers are usually located over pressure points, such as the toes and ankles, and are sharply demarcated with little granulation tissue and a punched-out appearance.
T
Arterial ulcers often have a necrotic-appearing wound base.
T
Arterial ulcers demonstrate the 6 P’s – pulseless, pain, pallor, poikilothermia, punched-out defect, pressure point location
T
The most characteristic lesion of the diabetic foot is a mal perforans ulceration.
T
Neuropathic ulcers most characteristically develop over the pressure points of the 2nd and 3rd metatarsal heads, and the great toes.
F 1st and 5th metatarsal heads, and great toes.
Venous ulcer pain is often described as a burning pain
T
Pain is more common with venous disease.
F Arterial disease.
Claudication and rest pain are characteristic of arterial ulcers
T
An ankle-brachial index (ABI) of 1.5 or higher is normal.
F 1.0 – 1.3
ABI of 0.4 or less may indicate severe arterial disease.
T
Neuropathic ulcers are typically a punched-out defect with a thick surrounding callus.
T
Probing of sinuses and deep ulcers is not a sensitive method for detecting bone infection.
F Is highly sensitive.
Care must be taken in using compression in patients with chronic heart failure – compression of the lower extremities can lead to an increase in preload volume and exacerbate their condition.
T
The Unna boot is a moist zinc oxide-impregnated paste bandage that hardens to inelasticity.
T
Multi-layer compression bandages provide no benefit over single-layer bandage systems.
F Multi-layer are superior.
The overall standard composition of multilayer compression bandages is: a wool or cotton layer, one or two elastic wraps, and a self-adherent wrap to hold all the layers in place and to maintain the proper position of the bandage on the leg.
T
Multilayer compression provide pressures of 60-80mmHg at the ankle and 30mmHg below the knee.
F 40-45mmHg at the ankle, 17mmHg below knee.
Aspirin has been associated with improved healing speed for venous ulcers.
T Via its anti-inflammatory action and its action on haemostatic mechanisms.
Pentoxifylline should not be used as an adjuvant to compression therapy.
F Effective adjuvant – 800mg tds.
In an acute wound, infection risk is greatest during the first 72-96hours after injury.
F 48-72hrs.
Detection of microorganisms from chronic leg wounds typically represents infection.
F Colonisation.
Predisposing factors for infection and colonised wound response include advancing age, diabetes, immune compromise, obesity, impaired circulation, malnutrition and remote infection.
T
Topical antibiotics should be used for leg ulcers.
F Use is controversial.
A moist wound environment induces acute wounds to re-epithelialize up to 40% faster than air-exposed wounds.
T
Debridement is the process of removing necrotic, devitalised tissue and foreign matter from a wound.
T
Regarding wound dressings for leg ulcers, hydrogels (eg Intrasite) are semitransparent, soothing, and do not adhere to wounds.
T
Regarding wound dressings for leg ulcers, alginates (eg. Kaltostat) are not absorbent or haemostatic.
F Are absorbent and haemostatic.
Regarding wound dressings for leg ulcers, alginates are best for highly exudative wounds, and partial or full-thickness wounds.
T
Regarding wound dressings for leg ulcers, hydrocolloids (eg Duoderm) are transparent, create a bacterial barriers and adhere without a secondary dressing.
F This is true for film dressings (eg Opsite, Tegaderm).
Regarding wound dressings for leg ulcers, hydrocolloids are indicated for partial- or full-thickness wounds, and stages 1-4 pressure ulcers.
T
Regarding wound dressings for leg ulcers, alginates require a secondary dressing.
T
Regarding wound dressings for leg ulcers, foams (eg Allevyn) are absorbent and conform to body contours.
T
Large wounds with a great amount of necrotic debris are particularly poor candidates for surgical debridement.
F Good candidates.
Surgical debridement is the treatment of choice for fulminant infection.
.
T
Mechanical debridement can be performed by applying wet-to-dry dressings, whirlpool baths and high-pressure irrigation
T
Wet-to-dry debridement does not affect viable wound tissue.
F Lifts away viable tissue within the wound.
Autolytic debridement involves using occlusive and semiocclusive dressings to promote a moist environment to accelerate the autolytic process.
T
Dressings suitable for autolytic debridement include hydrocolloids, hydrogels, alginates, and transparent films.
T
Autolytic debridement is typically more painful than wet-to-dry debridement.
F
Biosurgical debridement involves the application of maggots.
T
Enzymatic debridement is slower than autolytic debridement.
F
Enzymatic debridement commonly uses topical preparations of collagenase and papainurea.
T
The most common cause of graft failure is infection of the ulcer bed.
T
Lipodermatosclerosis does not affect ulcer healing.
F Poor prognostic factor.
Regarding graft types; epidermal grafts include cultured epidermal autografts and allografts
T
Regarding graft types; dermal replacements include integra
T
Regarding graft types; composite grafts include apligaf
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