Leg Ulcers

Question 1

What is a leg ulcer

Answer 1

Any break in the skin of the lower leg above the ankle present more than 4 weeks

Question 2

What are the majority of leg ulcers

Answer 2

Venous

Question 3

What are 2 underlying diseases that can cause leg ulcers

Answer 3

Rheumatoid

Diabetes

Question 4

How much of the population in the UK will have an ulcer in their lifetime

Answer 4

1%

Question 5

80% of patients with a leg ulcer need to be admitted. True or False

Answer 5

False

more than 80% can be managed in the community

Question 6

Why are leg ulcers important

Answer 6

Morbidity (pain, sepsis, exudate, odour)
Impaired quality of life
Financial cost

Question 7

What type of young patients may develop a venous ulcer

Answer 7

Diabetics

Substance abusers

Question 8

What types of leg ulcers are there

Answer 8

Venous
Arterial
Mixed venous and arterial 
Diabetic 
Vasculitic
Malignant
Hydrostatic

Question 9

Venous ulcers are often recurrent. True or False

Answer 9

True

Question 10

What might the location of the ulcer give us clues about

Answer 10

The underlying cause

Question 11

What are some of the signs of venous disease

Answer 11

Ankle swelling
Varicose veins 
Lipodermatosclerosis
Hyperpigmentation
Malleolus

Question 12

What is slough

Answer 12

Dead tissue/ debris that needs to be removed

Question 13

WHat is the normal range of an ankle/brachial pressure

Answer 13

0.8-1.3 normal

Question 14

How can you calculate the ABPI

Answer 14

ankle pressure / brachial pressure

Question 15

If the ABPI is

Answer 15

There is vascular disease

Question 16

If the ABPI is >1.5 what does this mean?

Answer 16

Calcification - there are hardened arteries and having a compression bandage would not work as the arteries are too occluded. Further investigation and treatment would be required first before compression

Question 17

Why would you swab an ulcer

Answer 17

If there are signs of infection

Question 18

What are the signs of infection of an ulcer

Answer 18

Increasing pain
Exudative
Smelly
Enlarging

Question 19

What blood tests would you do for a suspected infected leg ulcer

Answer 19

FBC
LFT
U&E
CRP

Question 20

What is the treatment for a venous ulcer

Answer 20

Control pain
ABPI
Non-adherent dressing
De-sloughing agent if necessary e.g. hydrogel/ honey
4 layer compression bandaging - may need to increase compression gradually if pain a problem
Leg elevation

Question 21

Describe a 4 layer bandaging system

Answer 21

Graduated compression

Question 22

What pressure should be applied to the leg

Answer 22

40mmHg at ankle and 25mmHg below the knee

Question 23

Why do we shape the leg into a cone

Answer 23

To aid with the pressure gradient

Question 24

How long should all ulcers be healed by

Answer 24

12 weeks

Question 25

Why is a dressing unlikely to heal an ulcer on its own

Answer 25

they are simple and non-adherent
They absorb liquid
They are good for antibacterial

Question 26

Manuka Honey dressings are the least painful dressings. True or false

Answer 26

False

They are on of the most painful

Question 27

What is the importance of compression stockings once the ulcer has healed

Answer 27

60% recurrence rate at 1 year if they are not used

Question 28

Who can apply a compression bandage

Answer 28

Only by staff with appropriate training

Question 29

What type of ulcer are deeper? Venous or Arterial

Answer 29

Arterial

Question 30

What is the main way to determine whether an ulcer is arterial or venous

Answer 30

Using the ABPI

Question 31

What does maggot therapy involve

Answer 31

They release an enzyme that softens and loosens the slough in helping to clean over the wound.
Very expensive but work very well

Question 32

What should you do if the ulcer is not improving

Answer 32

Re-assess the type of ulcer and therefore the treatment