Leg Ulceration Flashcards
How do venous ulcers develop?
Loss of valve competency in deep veins –> back pressure in small vessels –> resulting oedema further impairs blood flow –> poor tissue oxygenation impairs would healing and predisposes to infection
Describe a venous ulcer?
Large Superficial Gatar areaSigns of chronic venous disease May or may not be painful
What are some signs of chronic venous disease?
atrophie blanche chronic oedemalipodermatosclerosis varicose veins
Describe arterial ulceration
typically painful small, punched out ulcerstend to be deep occur over bony prominences and where there are end arteries usually dry base without granulation tissue
What does an APBI of >0.8 suggest?
Unlikely to be important
What does an APBI of 0.6-0.8 suggest?
unlikely to be limb threatening but impaired healing: consider intervention - reduced compression
What does an APBI of 0.4-0.6 suggest?
severe ischaemia: healing unlikely without intervention - no compression
What does an APBI of <0.4 suggest?
limb threatening ischaemia
What are the treatment options for venous ulcers?
compression superficial venous surgery skin grafting
What are the treatment options for arterial ulcers?
conservative chemical lumbar sympathectomy angioplasty bypass surgery
How should debris from the wound be removed?
physically chemically larval therapy
What else should be looked at when examining an ulcer?
Surrounding skin redness and scaling with pruritus indicates dermatitis
What are the Ddx when redness and scaling are seen?
gravitational eczema contact dermatitis from dressing etc
What are other causes of leg ulceration?
infection neoplasia vasculitis trauma pressure neuropathy pyoderma gangrenosum
What test should be carried out if eczema is suspected?
Patch testing (low threshold)
