Leg Ulcers

Question 1

What is a chronic leg ulcer?

Answer 1

Open lesion on lower leg that has remained unhealed for 4 weeks

Question 2

What causes chronic leg ulcers

Answer 2

Mostly due to venous status
20% due to PVD
5% due to diabetes

Others:
Autoimmune vasculitis, RA, SLE, TB

Question 3

How do arterial leg ulcers form?

Answer 3

PVD -> insufficient blood supply

Question 4

What causes venous leg ulcers?

Answer 4

High venous pressure resists venous return from legs

Leads to venous dilation -> varicose veins

Inc hydrostatic pressure -> RBC leakage into tissue

Poor blood supply impairs healing ability, so the skin in these areas break down

Question 5

How do venous ulcers present?

Answer 5

Majority occur in gaiter area (above medial mal)
Shallow, exudative, warm

Venous insufficiency signs eg ankle swelling, varicose veins, haemosiderin dep

Question 6

How do arterial leg ulcers present?

Answer 6

Usually affect the foot
Punched out, cold, white, shiny

PAD signs like intermittent claudication, or absent peripheral pulses
Pain at rest or lying down, relieved by hanging foot off bed

Question 7

How are leg ulcers investigated?

Answer 7

Assess the ulcer
ABPI for arterial disease
Duplex scan for DVT
Wound swab ONLY if signs of infection
Bloods

Patch test for various treatments

Question 8

How are arterial ulcers managed?

Answer 8

Reducing risk factors (ie treating causes of PVD)

Question 9

How are venous ulcers managed?

Answer 9

Control pain
De sloughing/debridement
4 layer compression bandaging- can be absorbent if needed
Maggots
Elevation
Surgery if needed