Leg Ulcers Flashcards
What is the definition of a leg ulcer?
Any break in the skin of the lower leg (above the ankle) that has been present for more than 4 weeks
What are the different types of leg ulcer?
Venous, arterial, diabetic, vasculitic, malignant, hydrostatic
How does the prevalence of leg ulcer vary with age?
Increases
Who treats leg ulcers?
80% dealt with in the community, 12% joint with community and secondary care and 5% in patient treatment
What are the effects of leg ulcers on the patient?
Reduced QoL, pain, sepsis, exudate, odour
What key topics should be covered during a leg ulcer history?
Duration of ulcer, is this the first ulcer, pain - sleep disturbance & mobility, medical history - DVT, varicose veins, vascular disease, diabetes, etc
During examination of a leg ulcer what should be payed particular attention to?
Position of the ulcer, size of the ulcer, quality of the leg as a whole (varicose veins, etc),
What features are characteristic of a venous ulcer?
Lipodermatosclerosis, hyperpigmentation (haemosiderin staining), affected gaiter area
What is slough?
Dead tissue and debris
What is the classification of circulatory disease in relation to ABPI monitoring?
- 8-1.3 - normal
1. 5 - calcification
Which investigations are indicated for chronic leg ulcers?
ABPI, wound swab and/or bloods (if signs of infection), patch testing (to previous ulcer treatments), duplex scan
What is the treatment for venous ulcers?
Analgesics, non-adherent dressing, de-sloughing agent (hydrogel/honey), 4 layer compression bandaging, leg elevation
Describe the 4 layer bandaging system
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)
4 layer bandaging aims to heal an ulcer in how many weeks?
12
Dressings are used to heal wounds. T/F
False - they alone rarely heal wounds
What are the different types of dressing and their respective uses?
Non-adherent - standard dressing
Hydrocolloids (e.g aquacel) dressings - absorptive
Silver/iodine dressings - antibacterial
Manuka honey dressings - antibacterial
What are the classes of compression stockings? What class do most patients use? When are compression stockings indicated?
Class 1 (weak), Class 2 (moderate) and Class 3 (strong). Class 2. After an ulcer has healed to prevent further ulcers
What dermatological condition may form around a chronic leg ulcer?
Stasis/venous dermatitis
What is atrophie blanche?
Star shaped, white, depressed atrophied plaques containing prominent red dots (dilated blood vessels) & surrounded by pigmentation
What is atrophie blanche associated with?
Venous insufficiency and diabetic vascular disease
Ulcers appearing on areas of pressure (e.g toes & heels) are usually a sign of which types of ulcer?
Arterial and diabetic
Which type of ulcer tends to have a “punched-out” appearance?
Arterial
Which type of ulcer tends to have shallow edges?
Venous
Where do venous ulcers typically develop?
Gaiter area
Where do diabetic and arterial ulcers typically develop?
The feet (pressure sites in particular)
A non-healing ulcer is a red flag for which other condition?
Cancer
How are infected ulcers cleaned?
Tap water and soap substitute
Maggots can be useful in the treatment of leg ulcers. T/F
True - for debridement
