Leg ulcers Flashcards
What is meant by a chronic leg ulcer?
An open lesions between the knee and ankle joint that remains unhealed for at least 4 weeks
What are the main 2 causes of ulcer formation?
Venous ulcers (60-80%)
Arterial ulcers (20%)
What are some other causes of ulcer formation?
- Vasculitis
- Neuropathic
- Diabetes
- Underlying conditions (E.g. pyoderma gangrenosum)
- Skin malignancy
- Inflammatory skin disease
What are some important points in history taking for leg ulcers?
- PMH (E.g. DVT, Varicose veins, Ankle swellings, knee replacements in venous) (PAD, claudication in arterial)
- Current medication
- Social circumstances
- Smoking
- Mobility
- Pain
- Sleep disturbance
How should a leg ulcer by assessed?
Record position (Venous closer to medial maleoli, arterial on periphery such as toes and feet)
Measure surface are
Where on the leg are venous ulcers most commonly found?
Around the medial malleolus
Where on the leg are arterial ulcers most commonly found?
On the periphery such as toes and feet
How deep are venous ulcers most commonly?
Superficial
How deep are arterial ulcers most commonly?
Deep
What causes an arterial ulcer?
A non-healing wound caused by a lack of arterial supply, resulting in decreased flow of clotting factors and possible ischaemia
What causes a venous ulcer?
A non-healing wound caused by lack of venous drainage of the wound site, resulting in decreased return of arterial blood
What are some investigations required for leg ulcers?
ABPI
Wound swab (Only if sign of infection)
Blood testing (If suspicion of diabetes or anaemia)
Patch testing (Ensures no allergies to dressings)
Biopsy (If suspicious of malignancy)
What is a normal ABPI?
0.8 - 1.3
What ABPI is suggestive of arterial disease?
< 0.8
What ABPI is suggestive of arterial calcification?
> 1.5
What condition is shown?
Varicose veins with possible venous dermatitis (Due to venous leakage onto the skin)
What condition is shown?
Venous dermatitis (Due to venous leakage onto the skin)
How is venous dermatitis treated?
Soaps and topical steroids
What condition is shown?
Lipodermatosclerosis and hyperpigmentation due to venous ulceration and stasis (Shows reverse champagne bottle sign with puffy upper leg due to stasis and scarred, thin lower leg)
What causes hyperpigmentation in lipodermatosclerosis (In venous ulceration)?
Haemosiderin leakage from veins causes brown skin discolouration
What condition is shown?
Arterial ulcer
What condition is shown?
Deep arterial ulcer
What condition is shown?
Vasculitis
What condition is shown?
Necrobiosis lipoidica - Loss of dermis of the skin in diabetes
What condition is this?
Pyoderma grangrenosum
What condition is shown?
Neuropathic ulcer - Common in diabetes due to diabetic neuropathy as wounds will go unnoticed
How is pain in venous ulcers managed?
Analgesics
What are the main ways of preparing wounds for dressing?
- Autolytic - Dressing creates a moist environment to hydrate the necrotic tissue (E.g. Hydrogel, Honey)
- Sharp debridement (Using scalpel or scissors)
- Biological (Using maggots)
- Surgical (Under general anaesthetic)
How are venous ulcers dressed after preparation?
Non-adherent dressings are applied, followed by 4 layer compression bandaging
What management can be used in severe venous ulcers?
Skin grafting
What are the colour changed of the wound healing continuum?
Black → Yellow - > Red → Pink
What are some possible complications of leg ulcers?
- Infection
- Contact allergy
- Malignant transformation
