Leg ulcers Flashcards
Definition of a leg ulcer?
Any break in the skin of the lower leg (below the knee) and above the ankle
In order from most common to least common, what are the different kinds of leg ulcers?
Venous Arterial Mixed arterial venous disease Rheumatoid arthritis Diabetic
Young person with leg ulcer?
IV drug user
Lipodermatosclerosis definition?
Thickening of the fatty layer
Hyerpigmentation?
Dark brown staining
What is slough?
Dead tissue that needs to cleaned away so the ulcer can heal
What investigations are used for a leg ulcer?
ABPI Wound swab (if infection) Bloods Patch testing Duplex scanning
Why is ABPI used?
To differentiate between arterial and venous ulcers
SIGN guidelines for ABPI?
1.5 calcification
May be so high that duplex will need to be used
Treatment of leg ulcers?
Analgesia e.g. paracetamol, amityptaline (good for night pain) Non-adherent dressing De-sloughing agent if necessary 4 layers of compression bandaging Leg elevation Compression stockings
What shape is compression bandaging in and why is this done?
Cone shape, separates out the pressure
For compression bandaging, what is the pressure at below the knee and at the ankle?
Ankle 40mmHg
Knee 25mmHg
In compression bandaging, how long is the aim for healing an ulcer?
12 weeks
What antibacterial agents can be added to dressings?
Silver / iodine
Manuka honey
What are the different stage of compression stockings?
1-3
When are compression stocking used in the treatment ofleg ulcers?
Once the ulcer has healed
What is stasis dermatitis and how is it treated?
Common inflammatory skin condition of lower extremities due to chronic venous insufficiency.
Treated with emollients, topical steroids, compression and treatment of underlying problems
What is Atrophie Blanche?
Atrophie blanche is the name given to a particular type of scar arising on the lower leg. It occurs after a skin injury when the blood supply is poor. May ulcerate
Where are common places for arterial ulceration to occur?
Heel, base of big toe etc. Places where there is applied pressure
Punched out ulceration?
Arterial ulceration
Pearly white appearance and talangectasia?
BCC
Where do venous ulcer usually occur?
Malleoli
Why are maggots used in therapy?
They release an enzyme that debrides the sough and cleans the wound. Used in atertial wounds. Afterwards they are incinerated
