Leg ulcers

Question 1

Roughly what proportion of leg ulcers have a venous aetiology?

Answer 1

60-80%

Question 2

What causes venous leg ulcers?

Answer 2

Sustained venous hypertension (in superficial veins) owing to incompetent valves or previous DVT. Leads to inadequate oxgenation and subsequent inflammation

Question 3

How do venous leg ulcers usually present?

Answer 3

Large, shallow irregularly bordered ulcers, usually at the level of mid-calf to medial malleolus

Question 4

What other signs may be seen in venous ulceration?

Answer 4

Lipodermatosclerosis
Atrophie blanche (scarring white atrophy with telangiectasia)
Eczema
Hyperpigmentation due to haemosiderin deposits

Question 5

Why is ABPI a useful investigation?

Answer 5

Allows you to differentiate between venous and arterial ulcers (ABPI is lower in arterial)

Question 6

Why is ABPI often abnormally high in diabetes?

Answer 6

Calcified vessels cause rigidity and artificially high readings

Question 7

When should a swab of an ulcer be taken?

Answer 7

Clinical suspicion of infection e.g. cellulitis

Question 8

What role does patch testing have in the investigation of leg ulcers?

Answer 8

If patient has associated dermatitis, use the “leg ulcer series” to check for allergy to dressings/preparations used in the management of the ulcer

Question 9

How are venous leg ulcers managed?

Answer 9

Analgesia
Debridement
Compression bandaging (pressure high at ankle, lower as you move up the leg- encourages blood to move)
Leg elevation
Compression stockings to help prevent recurrence