Leg Ulcers Flashcards
What leg ulcers?
Breaks in the skin that do not heal or heal slowly due to underlying pathology
What causes arterial, venous and mixed ulcers?
Arterial
Insufficient blood supply to the skin due to peripheral arterial disease
Venous ulcers
Occur due to pooling of blood and waste products in the skin secondary to venous insufficiency
Mixed
Combination of arterial and venous disease causing the ulcer
What causes diabetic foot ulceration?
Damage to both small and large blood vessels impair blood supply and wound healing
What contributes to ulceration and poor wound healing?
- Raised blood sugar
- Immune system changes
- Autonomic neuropathy
What is an important complication of diabetic foot ulceration?
Osteomyelitis
When do pressure ulcers typically occur?
Patients with reduced mobility
Prolonged pressure on particular areas leading to skin break down
Due to reduced blood supply, localised ischaemia, reduced lymph drainage
What scoring system is used to estimate patient’s risk of developing a pressure ulcer?
Waterlow score
What features help distinguish between arterial and venous ulcers?
Arterial
- Distally, affecting toes or dorsum of foot
- PAD association
- Smaller
- Deeper
- Well-defined borders
- Punched-out appearance
- Pale due to poor blood supply
- Less likely to bleed
- Painful
- Worse at night, when lying horizontally
- Worse on elevating and improved by lowering leg
Venous
- Gaiter area
- Chronic venous change association
- After minor injury
- Larger
- Superficial
- Irregular border
- More likely to bleed
- Less painful
- Relieved by elevation and worse on lower leg
What investigations are used for leg ulcers?
- ABPI
- FBC
- CRP
- HbA1c
- Charcoal swabs
- Skin biopsy (two week wait referral to dermatology)
How are arterial ulcers managed?
Urgent referral to vascular to consider surgical revascularisation
Debridement and compression not used in arterial ulcers
How are venous ulcers managed?
Referral to :
- Vascular surgery
- Tissue viability
- Dermatology
- Pain clinics
- Diabetic ulcer services
In community settings who deals with venous ulcer management?
Patient
District nurses
Tissue viability nurses
What does good wound care involve in venous ulceration?
Cleaning
Debridement
Dressing
How are venous ulcers treated?
Compression therapy
If arterial disease excluded with ABPI
Pentoxifylline
Improve healing, not licensed
Antibiotics
Treat infection
Analgesia
Manage pain Avoid NSAIDS worsens condition
