Leg ulcers Flashcards
What is the definition of a chronic leg ulcer?
An open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks
What should be investigated in a suspected ulcer?
Current medications
Social circumstances
Smoking - past or present
Mobility
Pain
Sleep disturbance
What is lipodermatosclerosis?
Chronic inflammation of subcutaneous fat in the lower limb caused by venous insufficiency
‘upside down champagne bottle’
What factors of an ulcer should be recorded in patient notes?
Position of ulcer
Side affected by ulcer
Surface area
What is vasculitis in relation to ulcers?
A sudden onset of painful purpuric rash / pustules around ulceration which can be necrotic
What is Necrobiosis lipoidica?
A rare diabetic condition which presents as yellow-red patches and ulcers on the shins
What is Pyoderma gangrenosum?
A non-infectious condition in which there are large painful ulcers on the lower limb
What is a neuropathic ulcer?
Ulceration due to nerve damage affecting the foot
Typically seen in people with diabetes and peripheral neuropathy
What investigation can be done for establishing the presence of arterial disease?
ABPI
When should a wound swab be carried out on an ulcer?
If the ulcer is increasingly painful or has exudate / malodour
What is a normal value for ABPI?
1
What ABPI suggests compression as an intervention?
Between 0.8 and 1.3
What ABPI reading suggests arterial disease?
Below 0.8
What ABPI reading suggests calcification?
Above 1.5
How are venous ulcers treated?
Pain control
Non-adherent dressing
4 layer compression bandaging
Leg elevation
De-sloughing agent if necessary
What is autolytic wound bed preparation?
The use of dressings to create a moist wound environment and hydrate necrotic tissue or eschar
What is sharp debridement in wound bed preparation?
The use of a scalpel or scissors to remove necrotic tissues
What is biological therapy in wound bed preperation?
Larvae therapy
How long should 4 layer compression take to heal ulcers?
Roughly 12 weeks
What type of skin grafting can be done in the treatment of ulcers?
Split skin grafting
Skin from abdomen used to encourage and promote skin growth in the area of ulceration
How should arterial ulcers be treated?
Supportive measures
Addressing modifiable factors and treating the underlying cause
What are the three most recognised complications of ulcers?
Infection
Contact allergy
Malignant transformation
Who is responsible for the application of compression bandaging?
Trained nurses or healthcare staff
If ulceration is advanced and not improving with typical treatment what should be done?
Referral to a specialist
What is slough?
Skin debris and dead tissue
