Leg Ulcers

Question 1

What are the key features of arterial ulcer?

Answer 1

Distal location= toes or dorsum of foot

Associated with PAD= absent pulses, pallor and intermittent claudication

Smaller and deeper than venous

Well-defined borders with punched out appearance

Pale= lack of blood supply

Painful

Worse at night or lying horizontal

Pain worse on elevation + better on lower= aids circulation

Question 2

What are the key features of venous ulcers?

Answer 2

Location on gaiter area of leg

Associated chronic venous changes= hyperpigmentation, venous eczema, lipodermatosclerosis

Larger + superficial

Irregular sloping border

Likely to bleed

Less painful

Any pain relieve by elevation and worsened by lower= increases pooling + pressure

Question 3

What investigations need to be for arterial/venous ulcers?

Answer 3

ABPI= assess for arterial disease

FBC + CRP= assess for infection + anaemia

HbA1c levels in diabetes if suspected diabetic ulcer

Charcoal swabs= when infection suspected

Skin biopsy= when skin cancer suspected

Assess for pulses

Question 4

How are arterial ulcers managed?

Answer 4

Treatment of underlying PAD

-should heal rapidly once PAD treated

Question 5

How are venous ulcers treated?

Answer 5

Compression therapy= GCS
-relieves high resting pressure to try and emulate ambulatory pressure to promote better healing

Wound cleaning and dedridment

Treat VV= decreases risk of recurrence

Exercise and nutrition to promote healing

Analgesia for related pain BUT avoid NSAIDs as can worsen condition

Question 6

How can you differentiate a diabetic ulcer from an arterial ulcer? What are the other features of a diabetic ulcer?

Answer 6

Arterial ulcers are painful whereas diabetic ulcers will either not be felt or be associated with pins and needles i.e. due to peripheral neuropathy in diabetes

Other features:
-located on ball of foot i.e. pressure points 
-deep lesion 
-usually progresses from callosity 
(ADD AFTER CTF SESSION)