Leg Ulcers

Question 1

What are features of arterial ulcers?

Answer 1

Painful at rest/elevation
Tend to be located on presure points e.g. heels/metatarsal heads
Deep and punched out
Cool/pale/cyanotic skin
Diminshed or absent pulses
Delayed CRT
Ulcer base may appear necrotic

Question 2

What investigations are required for arterial ulcer?

Answer 2

ABPI
<0.8= arterial insufficiency
<0.5= PAD related ulceration

Doppler US and arterial duplex imaging to assess blood flow

Question 3

What is the management of arterial ulcer?

Answer 3

Lifestyle modifications
Medication- antiplatlet/station
Revascularisation procedures and wound care

Question 4

What are features of venous ulcers?

Answer 4

Typically on lower legs near medical malleolus
Painful-worse on standing
Large and shallow irregular ulcer
Associated lipodermatosclerosis
Warm skin
Normal pulses
Venous eczema

Question 5

What is the investigation and management of venous ulcers?

Answer 5

Doppler US
ABPI >0.8

Compression bandages
Leg elevation
Wound Care

Question 6

What are features of neuropathic ulcers?

Answer 6

Normally on feet such as plantar surface
Often painless
Abnormal sensation
Signs of peripheral neuropathy
Variable size
Normal pulses

Question 7

What are the investigations/management for neuropathic ulcers?

Answer 7

Assess glycaemic control
Screen for neurpathy
ABPI >0.8 ( can be >1)
XR to exclude osteomyelitis

Optimise sugar control
Wound debridement
Offload pressure
Screen for diabetic complications
Wound care