Leg ulcers

Question 1

Chronic leg ulcer

Answer 1

Open lesion between the knee and the ankle joint

Remains unhealed for at least 4 weeks

Question 2

Venous - clinical presentation

Answer 2

Superficial ulcer
Swelling
Not usually painful - painful when standing
Painless when leg is elevated
Brown patches develop on skin - due to haemoglobin b/d
Skin may become itchy and scaly

Question 3

Venous - position of ulcer

Answer 3

Around medial and lateral malleoli

Between ankle and calf

Question 4

Venous - investigations

Answer 4

Check for peripheral pulses 
ABPI - doppler US 
Biopsy
Bloods 
Wound swab (only if infection is present)

Question 5

Venous - management

Answer 5

Wash leg with tap water and soap 
(or potassium permanganate if ulcer leaking heavily)
Put dressing over ulcer
Compression bandage (4 layer) 
Encourage leg elevation

Question 6

What substances are used to de-slough an ulcer?

Answer 6

Honey

Hydrogel

Question 7

Venous - comorbidities

Answer 7

Varicose veins

Previous DVT

Question 8

Arterial - clinical presentation

Answer 8

Deep ulcers - borders look punched out
Very painful - especially when legs are elevated
Foot cold to touch and pale
Pt classically hangs leg out of bed at night

Question 9

Arterial - position of ulcer

Answer 9

Feet, heels, toes

Question 10

Arterial - investigations

Answer 10

ABPI (<0.8 establishes arterial disease BUT doesn’t diagnose ulcer)

Question 11

Arterial - management

Answer 11

Refer for vascular surgery

Question 12

Rheumatoid arthritis ulcer

Answer 12

Arterial, multiple deep punched out ulcers

Question 13

Vasculitis

Answer 13

Inflammation of blood vessels

Painful, sudden onset, rash

Question 14

ABPI

Answer 14

Investigation used to see if we should use compression
1.0 = normal
0.8-1.3 = use compression
<0.8 = arterial disease, do not compress