Leg Ulcers

Question 1

What is the definition of a leg ulcer?

Answer 1

Any break in the skin of the lower leg (above the ankle) that has been present for more than 4 weeks

Question 2

What are the different types of leg ulcer?

Answer 2

Venous, arterial, diabetic, vasculitic, malignant, hydrostatic

Question 3

How does the prevalence of leg ulcer vary with age?

Answer 3

Increases

Question 4

Who treats leg ulcers?

Answer 4

80% dealt with in the community, 12% joint with community and secondary care and 5% in patient treatment

Question 5

What are the effects of leg ulcers on the patient?

Answer 5

Reduced QoL, pain, sepsis, exudate, odour

Question 6

What key topics should be covered during a leg ulcer history?

Answer 6

Duration of ulcer, is this the first ulcer, pain - sleep disturbance & mobility, medical history - DVT, varicose veins, vascular disease, diabetes, etc

Question 7

During examination of a leg ulcer what should be payed particular attention to?

Answer 7

Position of the ulcer, size of the ulcer, quality of the leg as a whole (varicose veins, etc),

Question 8

What features are characteristic of a venous ulcer?

Answer 8

Lipodermatosclerosis, hyperpigmentation (haemosiderin staining), affected gaiter area

Question 9

What is slough?

Answer 9

Dead tissue and debris

Question 10

What is the classification of circulatory disease in relation to ABPI monitoring?

Answer 10

0. 8-1.3 - normal

1. 5 - calcification

Question 11

Which investigations are indicated for chronic leg ulcers?

Answer 11

ABPI, wound swab and/or bloods (if signs of infection), patch testing (to previous ulcer treatments), duplex scan

Question 12

What is the treatment for venous ulcers?

Answer 12

Analgesics, non-adherent dressing, de-sloughing agent (hydrogel/honey), 4 layer compression bandaging, leg elevation

Question 13

Describe the 4 layer bandaging system

Answer 13

Non-adherent dressings get applied in a cone shape (ensuring graduated compression) by a trained professional and changed weekly or as required (if becoming saturated, etc)

Question 14

4 layer bandaging aims to heal an ulcer in how many weeks?

Answer 14

12

Question 15

Dressings are used to heal wounds. T/F

Answer 15

False - they alone rarely heal wounds

Question 16

What are the different types of dressing and their respective uses?

Answer 16

Non-adherent - standard dressing
Hydrocolloids (e.g aquacel) dressings - absorptive
Silver/iodine dressings - antibacterial
Manuka honey dressings - antibacterial

Question 17

What are the classes of compression stockings? What class do most patients use? When are compression stockings indicated?

Answer 17

Class 1 (weak), Class 2 (moderate) and Class 3 (strong). Class 2. After an ulcer has healed to prevent further ulcers

Question 18

What dermatological condition may form around a chronic leg ulcer?

Answer 18

Stasis/venous dermatitis

Question 19

What is atrophie blanche?

Answer 19

Star shaped, white, depressed atrophied plaques containing prominent red dots (dilated blood vessels) & surrounded by pigmentation

Question 20

What is atrophie blanche associated with?

Answer 20

Venous insufficiency and diabetic vascular disease

Question 21

Ulcers appearing on areas of pressure (e.g toes & heels) are usually a sign of which types of ulcer?

Answer 21

Arterial and diabetic

Question 22

Which type of ulcer tends to have a “punched-out” appearance?

Answer 22

Arterial

Question 23

Which type of ulcer tends to have shallow edges?

Answer 23

Venous

Question 24

Where do venous ulcers typically develop?

Answer 24

Gaiter area

Question 25

Where do diabetic and arterial ulcers typically develop?

Answer 25

The feet (pressure sites in particular)

Question 26

A non-healing ulcer is a red flag for which other condition?

Answer 26

Cancer

Question 27

How are infected ulcers cleaned?

Answer 27

Tap water and soap substitute

Question 28

Maggots can be useful in the treatment of leg ulcers. T/F

Answer 28

True - for debridement