Leg Ulcers Flashcards
Leg Ulcer
Definition
Risk Factors
- Advanced age
- Tobacco use
- Poorly-controlled diabetes
- Hypertension
-High cholesterol - Overweight/obesity
- Genetics/family history
Peripheral Vascular Disease
Definition
Pathophysiology
Condition of valvular incompetence leading to state of chronic venous insufficiency.
Atherosclerosis > venous stenosis (narrowing/hardening) > venous stasis > venous hypertension > increased capillary permeability > oedema > permanent structural and mechanical damage > peripheral ischemia.
Peripheral Vascular Disease
Signs & Symptoms
- Skin - hardened leathery skin
- Colour - red-brown discolouration
- Temp - localised warmth.
- Moisture - dry/flaky, eczema, brawny leakage.
- Veins - varicose, spider, tortuous, phlebitis.
- Pulses - intact
- CRT - normal
- Pain - minimal, relieved by elevation.
Ankle-Brachial Index
Venous Ulcers
Assessment
Location - lower 1/3 of leg.
Tissue - shallow, ruddy granulation; minimal slough.
Inflammation - redness, warmth.
Moisture - variable.
Edges - irregular, erythema of peri-skin.
ABI - 0.8-1.2
Note - exclude arterial involvement via ABI/ultrasound,
Venous Ulcers
Management
- Graduated compression therapy (30-40mmHg) toe-to-knee - e.g. bandages/stockings, sequential pumps,
- Positioning - elevation above heart level.
- Calf and foot exercises
- DVT prophylaxis
- MDT - podiatrist, pharmacists, GP/Dr.
- Lifestyle - manage co-morbidities/risk factors.
- Patient education
Peripheral Arterial Disease
Definition
Pathophysiology
Condition of arterial stenosis/atheroma leading to state of chronic arterial insufficiency.
Atherosclerosis of major arteries > arterial stenosis and atheroma > diversion of blood flow to smaller arteries > collateral blood flow unable to meet muscle demand on exertion > temporary ischaemia > progression to ischaemic rest pain/ulcers
Acute Limb Ischaemia
6 P’s
- Pallor
- Pulselessness
- Parasthaesia
- Paralysis
- Pain
- Poikilothermic
Peripheral Arterial Disease
Signs & Symptoms
- Skin/nails - shiny, hairless, thickened.
- Colour - pale/cyanosis, dependent rubor (dusky foot), pallor on elevation.
- Temp - localised coolness.
- Moisture - dry, flaking.
- Pulses - absent/diminished.
- CRT - sluggish.
- Pain - intermittent claudication (on exertion), on elevation, relieved by rest/dependent position.
- ABI < 0.9 (severe <0.5) or >1.2 (calcified arteries).
Arterial Ulcers
Assessment
Location - bony prominences/pressure points.
Tissue - base covered by slough or necrosis, exposed tendon.
Inflammation
Moisture - dry/minimal exudate.
Edges - sharply defined, punched-out.
Arterial Ulcers
Treatment
- Analgesia
- Positioning - recumbent/dependent.
- Re-vascularisation - e.g. stents, bypass grafts, angioplasty.
- MDT - surgeon, GP/Dr, physiotherapist/OT.
- Lifestyle - manage co-morbidities/risk factors.
- Patient education
- CONTRAINDICATED - debridement and compression.
- Amputation - LAST RESORT.
Neuropathic/Ischaemic Feet
Defintion
Pathophysiology
Loss of protective sensation and/or absent/diminished pulses.
Motor, sensory and autonomic neuropathy > physical deformity, sensory loss and skin drying > callus formation > ongoing trauma > subcutaneous haemorrhage and erosion > ulcer formation (+ PVD) > delayed wound healing > necrosis/gangrene
Neuropathic/Ischaemic Feet
Signs & Symptoms
Signs/symptoms:
- Impaired sensation
- Dry skin/fissures
- Callus/deformity
- Abnormal gait
- Nil sweating
- Bounding pulses
Diabetic Foot Ulcer
Assessment
Location - areas of foot exposed to pressure/trauma.
