Leg ulcers

Question 1

definition of a leg ulcer

Answer 1

Interruption in the continuity of an epithelial surface

Question 2

causes of leg ulcers

Answer 2

1. Venous: commonest
2. Arterial: large or small vessel
3. Neuropathic: EtOH, DM
4. Traumatic: e.g. pressure
5. Systemic disease: e.g. pyoderma gangrenosum
6. Neoplastic: SCC

Question 3

features of venous leg ulcers

Answer 3

• 75% of leg ulcers
• Painless, sloping, shallow ulcers
• Usually on medial malleolus: “gaiter area”
• Assoc. with haemosiderin deposition and
  lipodermatosclerosis

Question 4

risk factors for venous leg ulcers

Answer 4

venous insufficiency, varicosities, DVT, obesity

Question 5

features of arterial leg ulcers

Answer 5

- 2% of leg ulcers
Hx of vasculopathy and risk factors
- Painful, deep, punched out lesions
- Occur @ pressure points (Heal, Tips of. and between, toes, Metatarsal heads (esp. 5th))
- Other signs of chronic leg ischaemia

Question 6

features of neuropathic leg ulcers

Answer 6

• Painless with insensate surrounding skin

- Warm foot with good pulses

Question 7

complications of leg ulcers

Answer 7

• osteomyelitis

- Development of SCC in the ulcer (Marjolin’s ulcer)

Question 8

investigations of leg ulcers

Answer 8

• ABPI if possible
• Duplex ultrasonography
• Biopsy may be necessary (Look for malignant change: Marjolin’s ulcer)

Question 9

management of leg ulcers

Answer 9

• focus on prevention (graduated compression stockings, venous surgery)
• optimise risk factors (nutrition, smoking)
• analgesia
• bed rest + elevate leg
• 4 layer graded compression bandage (if ABPI >0.8)
• Pentoxyfylline PO (↑ microcirculatory blood flow, Improves healing rates)