Leg Ulcers

Question 1

What is this?

Answer 1

Venous leg ulcer

Question 2

What is this?

Answer 2

Arterial leg ulcer

Question 3

What is this?

Answer 3

Neuropathic ulcer

Question 4

What is this?

Answer 4

Diabetic foot ulcer

Question 5

What is the pathophysiology of venous leg ulcers?

Answer 5

Often secondary to venous HTN, chronic venous insuffciency or venous reflux

When valves are incomeptent or there is failure of the pump then venous HTN can occur

Deep venous insufficiency is due to DVT and superficial due to varicose veins

Ulcers form due to capillary fibrin cuff or leucocyte sequestration

Question 6

What are signs of venous insufficiency?

Answer 6

Oedema

Brown pigmentation

Lipodermatosclerosis - inflammation of layer of fat under the skin

Eczema

Question 7

How do you differentiate between venous and arterial leg ulcers?

Answer 7

Venous

• overlie the great saphenous vein
• on medial aspect of leg
• shallow and irregular shaped
• flat or sloping edges
• granualtion tissue at base

Arterial

• punched out appearance
• Over bony prominence
• common on lateral aspect
• lttile to no granulation tissue
• deep

Question 8

What are some complicatons of venous ulcer?

Answer 8

Cellulitis

Osteomyelitis

Contact irritant dermatitis to exudation and bacterial colonsiation

Contact allergic dermatitis due to medications

Question 9

What is the management of venous leg ulcers?

Answer 9

Compression dressings or elastic stokcings to decrease oedema and aid venous return

Avoid trauma to affected area

Skin grafitng if ulcer resistance to treatment

Abx if infection

Question 10

What are the ranges for ABPI?

Answer 10

>1.4= some calcifcations may be present

1-1.4= probably no arterial disease

0. 81-1.00= no significant or mild disease
1. 5-0.8= moderate disease
2. 3-0.5= severe disease

<0.3= critical ischaemia