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Vascular > Leg Ulceration > Flashcards

Leg Ulceration Flashcards

1
Q

What are the classifications of leg ulcers?

A
  1. Ischaemic/arterial insufficiency aka peripheral arterial disease
  2. Neuropathic
  3. Stasis/venous
    Other:
    - Infective: syphilis, myco, osteomyelitis
    - Neoplastic: SCC, BCC, melanoma, Kaposi’s sarcoma
    - Systemic: pyoderma gangrenosum
    - Traumatic: thermal burns, bites, radiation
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2
Q

Causes of neuropathic leg ulcers

A
  • DM
  • EtOH
  • Spinal cord lesions
  • Tabes dorsalis: untreated syphillis infection can lead to slow demylination of the dorsal column nerves
  • Syringomyelia: cyst forms within on spinal cord
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3
Q

Hx of ischaemic ulcers

A

Hx:

  • V. painful
  • Hx of claudication
  • CV risk factors
  • Previous peripheral vascular surgery
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4
Q

Describe how an ischaemic ulcer appears on inspection

A
  • Location: distal periphery, over dorsum of foot or pretibia
  • Punch-out edges
  • Ulcer base => poorly developed gray granulation tissue
  • Surrounding skin is pale or mottled with no signs of inflammation
  • Little bleeding when debrided
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5
Q

Hx of neuropathic ulcers

A
  • Painless

- Hx of Dm or other causes of neuropathy (DM, EtOH, spinal cord lesions, syringomyelia, tabes dorsalis

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6
Q

Describe how an neuropathic ulcer appears on inspection

A
  • Deep
  • Location:
    a. pressure points or calluses
    b. plantar surface of MTP joints
    c. “Bunion” or “bunionette” areas
    d. Dorsum of IP joints
    e. Base of 5th MT
    f. MM or LM
    g. Callused posterior rim of heel pad
  • features of distorted foot architecture:
    a. Hyperextension of MTP joints
    b. Hyperflexion of IP joints
    c. Charcot’s deformity
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7
Q

List signs of neuropathy

A
  • Hypoaesthesia
  • proprioception
  • 2-point discrimination
  • Vibratory perception
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8
Q

Hx of venous ulcers

A
  • Hx of venous insufficiency: varicose veins, superfiicla thrombophlebitis or DVT, variceal bleeding
  • Previous venous surgery
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9
Q

Describe how an venous ulcer appears on inspection

A
  • Larger and irregular edge
  • Shallow
  • Location: over gaiter area (commonly medial malleolus)
  • Moist granulating base
  • Surrounded by zone of inflammation and stasis dermatitis
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10
Q

What are the associated signs of venous insufficiency (if suspecting venous ulcer)?

A
  • varicose veins
  • pitting oedema
  • varicose eczema
  • Pigmentation
  • Lipodermatosclerosis (champagne leg)
  • Atrophie blanche (white stellate scars)
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11
Q

Compare the ulcers (arterial, venous, neuropathic) in SITE

A
  1. Arterial
    distal at toe tips
    Pressure areas
  2. Venous
    gaiter area
3. Neuropathic
dorsum of PIP / DIP
Plantar surface MTP
MM or LM
Heel
Other calloused areas
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12
Q

Compare the ulcers (arterial, venous, neuropathic) in SIZE/SHAPE/DEPTH

A
  1. Arterial
    small deep
  2. Venous
    Large, irregular, shallow
  3. Neuropathic
    Variable
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13
Q

Compare the ulcers (arterial, venous, neuropathic) in BASE

A
  1. Arterial
    pale and sloughy
  2. Venous
    granulating
  3. Neuropathic
    granulating
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14
Q

Compare the ulcers (arterial, venous, neuropathic) in EDGES

A
  1. Arterial
    punched out
  2. Venous
    sloping and shallow
  3. Neuropathic
    punched out
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15
Q

Ix of leg ulcers

A
  • FBE / U&E / CRP / glu / HbA1C / vasculitic screen / ESR / thrombophilic screen
  • Swab m/c/s
  • Xray ± bone scan ± MRI
  • Duplex (arterial or venous)
  • CTA
  • DSA
  • Biopsy
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16
Q

Rx of leg ulcers

A
  • Bed rest
  • Elevation or dependency
  • IV antibiotics
  • Dressings
  • Debridement / split skin graft
  • Treat underlying aetiology
    a. Revascularisation
    b. Compression stockings / Varicose vein surgery
    c. Pressure offloading footwear / Total contact cast

Vascular (6 decks)

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