Leg ulcers Flashcards
What is a leg ulcer?
A break in the skin of the lower leg above the ankle that has been present for more than 4 weeks
What types of leg ulcer are there?
Venous Arterial Mixed Rheumatoid arthritis associated Diabetic Vasculitic Malignant Hydrostatic
What is the relationship between leg ulcers and age?
Leg ulcers increase with age
Who treats most leg ulcers?
Community care
Which type of young patients get leg ulcers?
IV drug users
Diabetics
What type of morbidity does leg ulcers cause?
Pain
Sepsis
Odour
Exudaye
What are important history questions to ask about a leg ulcer?
Duration/first ulcer
Pain
Mobility
Sleep disturbance
What are relevant aspects of a medical history in a patient with a leg ulcer?
Peripheral vascular disease Diabetic DVT Clotting disorders Arterial disease Varicose veins
How should an ulcer be assessed?
Position of ulcer
Measurement of ulcer size
What type of ulcer will have haemosiderin staining? Why is this?
Venous
Red blood cells forced out of capillaries
What are the features of a venous ulcer?
Shallow edge/border Lipodermatosclerosis Hyperpigmentation Gaitor area (malleolus) Slough
What is slough? What does it indicate?
Dead tissue and debris
Ulceration (NOT infection)
How can suspected vascular disease be investigated? What categories can the results be divided into?
Ankle brachial blood pressure index (ABPI)
- 8-1.3 - normal
- 81.3 - calcification
How can an ulcer be investigated? Why is each useful?
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
When should an ulcer swab be taken?
When there are signs of infection - increasing redness, swelling, heat, pain, etc
How should a venous ulcer be treated?
Analgesia ABPI Non-adherent dressing De-sloughing (hydrogel, honey) 4 layer compression bandaging Leg elevation
Why might you have to be careful with 4 layer compression bandaging?
Painful legs will need gradual compression
How often should compression bandaging be changed?
Weekly
As required
How soon should ulcers heal with compression bandaging?
Within 12 weeks
Do dressings heal leg ulcers?
No it’s whats added to them
Absorbants - aquacel (hydrocollid)
Antibacterial - silver/iodine, manuka honey
Most leg ulcers reoccur without prevention. T/F
True
What skin conditions are associated with venous leg ulcers?
Venous dermatitis
Atrophie blanche
What is atrophie blanche?
Scarring resulting from skin injury where the blood supply is poor (e.g post venous ulcer)
Where do vascular and/or diabetic ulcers typically arise?
Where there is most pressure (i.e heals and toes)
What is the typical features of an arterial ulcer?
Punched out
Ulcers can undergo malignant transformation. T/F
True - but cancer can also present as a non-healing ulcer
How are infected ulcers cleaned?
Water and soap substitute
Can maggots be used in ulcer care?
Yes
