Leg Ulcers Flashcards
What are leg ulcers?
Wounds or breaks in the skin that do not heal or heal slowly due to underlying pathology
Types of skin ulcers
Venous ulcers
Arterial ulcers
Diabetic foot ulcers
Pressure ulcers
What do arterial ulcers result from?
Insufficient blood supply to the skin due to peripheral arterial disease
What are venous ulcers due to?
Pooling of blood + waste products in the skin secondary to venous insufficiency
What are mixed ulcers?
Combination of arterial + venous disease causing the ulcer
Features of arterial ulcers
- occur distally - toes + dorsum of foot
- associated peripheral arterial disease - absent pulses, pallor, intermittent claudication
- smaller + deeper than venous
- well defined borders
- punched out appearance
- pale
- painful
- worse when lying horizontally + elevation
- improves on lowering leg
What makes arterial ulcers better/worse?
- worse: when lying horizontally + elevation
- better: lowering leg
Features of venous ulcer
- occur in gaiter area (between top of foot + bottom of calf) - often over medial malleolus
- assocaited with chronic venous changes e.g. hyperpigmentation, venous eczema
- occur after minor injury
- larger + more superficial than arterial
- more likely to bleed
- less painful
- relieved by elevation
- worsens on lowering
What makes venous ulcers worse/better?
- worse: lowering leg
- better: elevation
Investigations of leg ulcers
- ankle brachial pressure index
- blood tests for infection + co-morbidities: FBC, CRP, HbA1c, albumin
- charcoal swabs
- skin biopsy if skin cancer is suspected > 2WW
What can be used to determine causative organism of infection of ulcers?
Charcoal swabs
Management of arterial ulcers
- referral to vascular to consider surgical re vascularisation
- treat underlying arterial disease
- debridement is NOT used
Management of venous ulcers
- vascular surgery if mixed ulcer suspected
- tissue viability clinics for non-healing ulcers
- cleaning wound, debridement + dressing
- compression therapy
- oral pentoxifylline
- abx for infection
- analgesia (avoid NSAIDs)
What drug can be used to help with healing of venous ulcers?
Oral pentoxifylline
What is an important complications of diabetic foot ulcers?
Osteomyelitis
What is the imaging of choice for osteomyelitis?
MRI
What are pressure ulcers due to?
- prolonged pressure to area > skin breaking down
- due to reduced blood supply, localised ischamia, reduced lymph drainage
What can be done to reduce risk of pressure ulcers?
- regular repositioning
- inflating mattresses
- regular skin checks
- protective dressings + creams
What score is used to assess risk of pressure ulcer development?
Waterlow score
How is venous insufficiency confirmed?
Duplex USS
Risk factors of arterial ulcers
- peripheral arterial disease
- diabetes mellitus
- HTN
- Hyperlipidaemia
- obesity
- inactivity
Risk factors of venous ulcers
- pre-existing venous insufficiency
- history of VTE
- pregnancy
- obesity
- sedentary lifestyle
What is a Marjolin ulcer?
Rare type of cutaneous SSC
Developing at site of severe or recurrent inflammation
Presentation of marjolin ulcer
- non healing ulcer
- steadily increasing in size
- excessive granulation tissue
- bleeding easily
- painful
Features of neuropathic ulcers
- commonly over plantar surface of metatarsal head + hallux
- due to pressure in peripheral neuropathy
- good pulses
