Leg ulceration Flashcards
What causes venous ulcers?
secondary to venous reflux and/or calf muscle pump dysfunction
neuromuscular dysfunction, or damage following deep vein thrombosis or thrombophlebitis
Chronic lymphoedema
What causes arterial ulcers?
progressive atheromatous changes
cholesterol emboli
Raynaud’s phenomenon, trauma and circulatory collapse as in cardiac arrest.
What are the less common causes of leg ulceration?
vasculitic diseases such as polyarteritis nodosa, inflammatory conditions like pyoderma gangrenosum, as well as neoplasms.
risk of a neoplasm arising in an area of chronic inflammation (rolled proliferative edge
What are the clinical features of an arterial ulcer?
Claudication
ischaemic rest pain. Peripheral pulses may be weak or absent
Capillary refill time increased
Painful
occur over a bony prominence, at the tips of digits, or at other sites after minor trauma.
Round, with sharply demarcated borders (a “punched out” appearance). There is little or no granulation tissue and the base is often dry.
Exposure of tendon or bone is more suggestive of arterial
Surrounding skin may be cool, hairless, dry and shiny.
What are the clinical features of a neuropathic ulcer?
Burning, altered sensation or paraesthesia
Often painless
Deep tendon reflexes may be depressed or absent
Area of pressure and there is often a thick rim of surrounding callus.
deep, with a “punched out” appearance.
What are the clinical features of a venous ulcer?
Limb heaviness, aching and ankle swelling
Varicose veins may be present
Haemosiderin deposition causing red-brown discoloration is common. lipodermatosclerosis
Atrophie blanche- smooth, white, sclerotic plaques
Larger, gaiter area, circumferential, overlyign course of saphenous vein
irregular shape, shallow in depth, with flat or sloping edges. There is usually healthy granulation tissue in the base.
What are the treatments for venous ulcers?
elevation and compression, having excluded co-existing arterial insufficiency
wear lifelong graduated compression hosiery to prevent recurrence
Skin grafting
Superficial venous surgery has been shown to promote ulcer healing in patients with superficial venous incompetence only.
How are arterial/neuropathic ulcers treated?
surgical re-vascularisation and management of vascular risk factors.
treat co-existing arterial disease and relieve pressure at the site
Therapeutic footwear will be a lifelong necessity to prevent new ulcers Callosities should be aggressively debrided
Tight glycaemic control in diabetics
How does pyoderma gangrenosum present?
Associated with IBD and diabetes
Painful ulceration
Short history
Treated with oral prednisolone
