leg ulcers Flashcards
what is the definition of a chronic leg ulcer?
open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks
what are the symptoms?
pain
leakage
smell
infection
social isolation
impaired quality of life
what are the two types?
venous and arterial
what are the subtypes?
vasculitic
malignant
inflammatory
hydrostatic - dependant limb
what are some key parts of history?
PMHx
current meds
social circumstances
smoker past or present
mobility
pain
sleep disturbance
what may be seen on exam?
lipodermatosclerosis - inverted champagne bottle
venous dermatitis
hyperpigmentation
how is an ulcer assessed?
record position of ulcer
measure surface area
what are the symptoms and signs of vasculitis?
painful
sudden onset
purpuric rash/pustules
necrotic
what investigations are used?
ABPI - confirm if it is arterial disease
wound swab - only if ulcer increasingly painful/exudate/malodour/enlarging
patch test - to previous ulcer treatment. bandages etc
what does ABPI measure and what are the ranges?
highest ankle systolic (ulcer leg)/highest brachial systolic
1 - normal
0.8-1.3 - compress
<0.8 - arterial disease
>1.5 - calcification
what is the treatment for venous ulcer?
control pain
ABPI
non-adherent dressings
de-sloughing agent if necessary
4 layer compression bandaging -> can increase if pain is a problem
leg elevation
what is the management of other causes of leg ulcers?
supportive/symptomatic
address modifiable factors - smoking/cholesterol/bp/diabetes
treat underlying cause
refer
what are complications of managing ulcers?
infection
contact allergy
malignant transformation
a patient presents with:
burning, leg hot to touch, red, not itchy, scaly, also has rash on elbow
what could it be?
psoriasis
