Leg ulcers

Question 1

What is a leg ulcer?

Answer 1

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

Question 2

What types of leg ulcer are there?

Answer 2

Venous
Arterial
Mixed 
Rheumatoid arthritis associated
Diabetic
Vasculitic
Malignant 
Hydrostatic

Question 3

What is the relationship between leg ulcers and age?

Answer 3

Leg ulcers increase with age

Question 4

Who treats most leg ulcers?

Answer 4

Community care

Question 5

Which type of young patients get leg ulcers?

Answer 5

IV drug users

Diabetics

Question 6

What type of morbidity does leg ulcers cause?

Answer 6

Pain
Sepsis
Odour
Exudaye

Question 7

What are important history questions to ask about a leg ulcer?

Answer 7

Duration/first ulcer
Pain
Mobility
Sleep disturbance

Question 8

What are relevant aspects of a medical history in a patient with a leg ulcer?

Answer 8

Peripheral vascular disease
Diabetic
DVT
Clotting disorders
Arterial disease
Varicose veins

Question 9

How should an ulcer be assessed?

Answer 9

Position of ulcer

Measurement of ulcer size

Question 10

What type of ulcer will have haemosiderin staining? Why is this?

Answer 10

Venous

Red blood cells forced out of capillaries

Question 11

What are the features of a venous ulcer?

Answer 11

Shallow edge/border
Lipodermatosclerosis
Hyperpigmentation
Gaitor area (malleolus)
Slough

Question 12

What is slough? What does it indicate?

Answer 12

Dead tissue and debris

Ulceration (NOT infection)

Question 13

How can suspected vascular disease be investigated? What categories can the results be divided into?

Answer 13

Ankle brachial blood pressure index (ABPI)

0. 8-1.3 - normal
1. 81.3 - calcification

Question 14

How can an ulcer be investigated? Why is each useful?

Answer 14

ABPI - differentiates between arterial and venous
Wound swab - test for infection
Bloods - FBC, LFT, U&E, CRP
Patch testing - test for allergy to ulcer treatments
Duplex if clinical suspicion

Question 15

When should an ulcer swab be taken?

Answer 15

When there are signs of infection - increasing redness, swelling, heat, pain, etc

Question 16

How should a venous ulcer be treated?

Answer 16

Analgesia
ABPI
Non-adherent dressing
De-sloughing (hydrogel, honey)
4 layer compression bandaging
Leg elevation

Question 17

Why might you have to be careful with 4 layer compression bandaging?

Answer 17

Painful legs will need gradual compression

Question 18

How often should compression bandaging be changed?

Answer 18

Weekly

As required

Question 19

How soon should ulcers heal with compression bandaging?

Answer 19

Within 12 weeks

Question 20

Do dressings heal leg ulcers?

Answer 20

No it’s whats added to them
Absorbants - aquacel (hydrocollid)
Antibacterial - silver/iodine, manuka honey

Question 21

Most leg ulcers reoccur without prevention. T/F

Answer 21

True

Question 22

What skin conditions are associated with venous leg ulcers?

Answer 22

Venous dermatitis

Atrophie blanche

Question 23

What is atrophie blanche?

Answer 23

Scarring resulting from skin injury where the blood supply is poor (e.g post venous ulcer)

Question 24

Where do vascular and/or diabetic ulcers typically arise?

Answer 24

Where there is most pressure (i.e heals and toes)

Question 25

What is the typical features of an arterial ulcer?

Answer 25

Punched out

Question 26

Ulcers can undergo malignant transformation. T/F

Answer 26

True - but cancer can also present as a non-healing ulcer

Question 27

How are infected ulcers cleaned?

Answer 27

Water and soap substitute

Question 28

Can maggots be used in ulcer care?

Answer 28

Yes