Leg Ulcers

Question 1

Define “leg ulcer”

Answer 1

Any break in the skin of the lower leg, above the ankle, present for more than 4 weeks

Question 2

The majority of leg ulcers are arterial in nature. True/False?

Answer 2

False

Majority are venous ulcers

Question 3

List characteristics of a venous ulcer

Answer 3

• Shallow, large, sometimes painful
• Due to incompetent valves > venous stasis + increased venous pressure.
• Common above medial malleoli (ankle bone) and on shin
• superficial

Question 4

ABPI is measured for ulcer patients. What are the normal limits for ABPI?

Answer 4

0.9-1.3

Question 5

ABPI of less than 0.8 indicates what?

Answer 5

Vascular disease

Question 6

ABPI of more than 1.5 indicates what?

Answer 6

Calcification

Question 7

When would a wound swab of an ulcer be done?

Answer 7

If smelly/painful/exudative/enlarging

Question 8

Name 2 de-sloughing agents

Answer 8

Hydrogel

Honey

Question 9

What is the gold standard treatment for leg ulcers?

Answer 9

Compression bandaging + non-adherent dressing

Question 10

Where do diabetic and arterial ulcers tend to present?

Answer 10

Feet
Pressure sites (heel)

Question 11

What are the risk factor for venous ulcers?

Answer 11

o	Obesity
o	Immobility
o	Varicose veins
o	Recurrent DVT
o	Age

Question 12

What are the signs of a venous ulcer?

Answer 12

o Oedema of the lower legs
o Hyperpigmentation
o Stasis eczema

Question 13

What is the name of the condition described as woody tethered skin affecting lower leg (invited champagne bottles)?

Answer 13

Lipodermatosclerosis

Question 14

What is slough?

Answer 14

Debris on ulcer (dead skin, bacteria etc). It must be removed for the ulcer to heal

Question 15

What should leg ulcers be cleaned with?

Answer 15

Warm tap water and soap

After it has healed, must wear compression stockings to prevent recurrence.

Question 16

What is is called when there are inflamed blood vessels?

Answer 16

Vasculitis

Question 17

Why do arterial ulcers occur?

Answer 17

Due to inadequate arterial blood supply to skin

Question 18

Where do arterial ulcers occur?

Answer 18

Occurs distal at dorsum of foot or between toes

Question 19

What are the risk factors for arterial ulcers?

Answer 19

o Coronary heart disease
o Peripheral arterial disease
o Obesity and immobility
o Diabetes

Question 20

What are the signs of an arterial ulcer?

Answer 20

o Night pain
o Hairlessness
o Cold peripheries
o Absent pulses
o Pain alleviated when leg dangling off bed

Question 21

What are the investigations for arterial ulcers?

Answer 21

ABPI
Duplex ultrasound
ECG

Question 22

What is the management for arterial ulcers?

Answer 22

Improve circulation- Exercise, angioplasty, bypass

Treat infections, remove dead tissue

Question 23

What are the signs of malignant ulcers?

Answer 23

o Rolled edges
o If the ulcer does not seem to be healing
o No vascular cause

Question 24

What are ulcers with a lack of sensation?

Answer 24

Neuropathic ulcers

Question 25

When are neuropathic ulcers common?

Answer 25

Common in diabetics

Question 26

What are the symptoms of necrotising fasciitis?

Answer 26

Flu like symptoms
Intense pain that is out of proportion with findings
Erythema+swelling with a well defined edge (in some cases skin may appear normal).