Leg Ulcers (2)

Question 1

What is an Ulcer?

What are the 2 vessel types?

What occurs in Diabetic foot?
→ Who’s this more common in?
→ What is an important complication here?

Answer 1

➊ Area of discontinuation of surface epithelium

➋ • Venous – Pooling of blood and waste products in skin secondary to venous insufficiency
• Arterial – Insufficient blood supply to the skin due to peripheral artery disease

➌ Raised blood sugar leads to ulceration and poor healing
→ Those with diabetic neuropathy, where they’ve lost sensation to feet
→ Osteomyelitis

Question 2

Arterial Ulcer:
Where do they occur?

How does it present?

What worsens and improves it?

What is it associated with?

Answer 2

➊ Distally, affecting toes or dorsum of foot

➋ • Small, Deep, Pale, Well-defined borders
• Painful
• Punched-out appearance

➌ Worse on elevating, Improved by lowering the leg as gravity helps circulation

➍ Peripheral arterial disease (absent pulses, pallor, intermittent claudication)

Question 3

Venous Ulcer:
Where do they occur?

How does it present?

What worsens and improves it?

What is it associated with?

Answer 3

➊ Gaiter Area (between top of the foot and bottom of calf)

➋ • Large, Superficial, Red, Poorly-defined borders
• Less painful
• Irregular appearance

➌ Worse on lowering, Improved by elevating the leg

➍ Chronic venous changes/insufficiency

Question 4

Which investigations should be done?

What is the management of an arterial ulcer?

What is the management of a venous ulcer?

Answer 4

➊ • Bloods – FBC, CRP, HbA1C
• ABPI

➋ Same as PAD, with surgical revascularisation

➌ Tissue viability clinics, Diabetic ulcer services, Clean wound, Debridement, Wound dressing
• Compression therapy (PAD has to be excluded first)
• Abx if infection