Leg Ulcers Flashcards
Define an ulcer?
A skin break with a loss of the epidermis and part or all of the dermis.
Describe the features of venous ulcers?
- Large
- Superficial
- Gaiter area
- Signs of chronic venous disease
- May or may not be painful
Describe the aetiology of venous insufficiency?
Failure of calf pump mechanism, aka immobility can cause venous insufficiency.
Incompetent valves
What are the features of venous insufficency?
VVVLAPS
- Varicose veins
- Venous eczema
- Venous ulcers
- Lipodermatosclerosis (inflammation of subcutaneous fat)
- Atrophie blanche (type of scarring arising on the lower leg due to venous insufficiency)
- Pitting oedema
- Scars
What are some of the complications of venous ulceration?
Superficial infection
Cellulitis
Lymohoedema
Contact dermatitis from dressings and ointments
(assciated eczema - venous eczema)
Describe the features of arterial ulcers?
- Punched out
- Necrotic
- Over pressure areas
- Painful
- Symptoms of arterial disease
What is an ABPI and what are the different degrees depending on the score?
Ankle Brachial Pressure Index
Assess the the difference in bp betwen the ankle and arm.
- ABPI >0.8 – unlikely to be important
- ABPI 0.6 - 0.8 – unlikely to be limb threatening but impaired healing: consider intervention – reduced compression
- ABPI 0.4 - 0.6 – severe ischaemia: healing unlikely without intervention – no compression
- ABPI <0.4 – limb threatening ischaemia
What are the treatments for Venous ulcers?
Compression, dressings, reducing risk of infection.
Superficial venous surgery can be done.
In severe cases skin grafting.
What are the treatments of arterial ulcers?
Conservative: Increase walking to encourage collateralls and lifestyle changes (STOP SMOKING)
Angioplasty.
Bypass surgery.
When should you consider using larvae therapy?
As a debridement agent as the larvae only eat necrotic skin it therefore removes this skin reducing infection risk.
Where do neuropathic ulcers most commonly occur, what it the most common joint aetilogy?
They usually occur in diabetics with peripeheral neuropathy and therefore usually occur on the foot. Can also have a venous or arterial cause also.
Venous ulcers are much more common and therefore are also much more common in diabetics.
What are the causes of vasculitic leg ulcers?
- Inflammatory causes
- SLE
- Rh disease
- Polyarteritis Nodosa
- Henoch Schonlein Purpura
- Drugs
- Small vessel occlusion
- Septic emboli (SBE, meningococcus)
- Cellular debris (sickle cell disease)
- Hyperviscosity (myeloma, cryoglobinaemia-Hep C)
- Neoplasia related emboli (pancreatic Ca)
Name the type of ulcer?
Arterial
Punched out and necrotic
Name the type of ulcer?
Neuropathic ulcer
Name the type of ulcer?
Vasculitic ulcer
Name the type of ulcer?
Venous
Name the condition and what is associated with?
Atrophie Blanche
Venous Insufficicency
Name the condition and what it is assocaited with?
Lipodermatosclerosis
Venous Insufficiency
