Leg Ulcers Flashcards
what is a chronic leg ulcer?
open wound between knee and ankle that remains unhealed for more than 4 weeks
what are the most common type of leg ulcer?
venous > arterial > rheumatoid arthritis > diabetic (neuropathy) > mixed
who are leg ulcers common in?
IV drug users
elderly
diabetics
cardiovascular patients
are leg ulcers usually treated in or out of hospital?
usually in the community
what contributes to the cost of venous leg ulcers?
delay in assessment, diagnosis and ABPI measurements
delays in commencing compression or confidence in applying compression bandages
what else can cause similar symptoms to a leg ulcer?
vasculitis - vasculitic rash
malignancy
inflammation
order of assessment of a leg ulcer?
patient
leg
ulcer
relevant history for leg ulcers?
steroids smoking status mobility nutrition cardio disease home help extent of pain
how can lack of mobility cause a leg ulcer?
muscle pump not in use so not pumping blood back up the leg causing it to leak out
are there any muscles in veins?
no
therefore varicose veins can develop if immobile etc as well as blood leaking out of vessels
what is lipodermatosclerosis?
woody, tethered, sclerotic skin in relation to venous hypertension?
what is venous dermatitis?
eczema secondary to venous hypertension
scaling around the ankle and visible veins in foot
where are each type of ulcer ulcers most common?
venous = gaiter area (highest pressure)
heel common place for pressure ulcer
toes = diabetic neuropathy
what is slough?
debris
dead skin cells, bacteria and exudate which can slow down healing
what does an arterial ulcer look like?
pale, hairless leg
sharp, punched out lesion
deeper
unusual/ulcerated toe region
what can mimic a leg ulcer?
necrobiosis lipoidoca
what commonly causes vasculitis?
antibiotics
also results in widespread rash
normal ABPI?
around 1
< 0.8 = vascular disease
>1.5 = calcification
0.8-1.3 = needs compression
what can a venous ulcer be confused with?
BCC
if not healing with compression - think it might not be an ulcer
how are ulcers investigated?
APBI
only swab if strong evidence of infection
Bloods (FBC, LFTs, U&Es, CRP)
patch testing if they also have bad eczema as treatment could be causing it
Duplex if needed
how are venous ulcers treated?
pain control ABPI Non-adherent dressing de - sloughing (hydrogel, honey etc) 4 layer compression bandaging leg elevation (above hip height)
when are compression stockings used?
if small ulcer
after ulcer has healed as prophylaxis
how quickly are ulcers aimed to be healed?
by 12 weeks
how is slough removed?
honey, hydrogels
how can a wound site be cleaned/prepared/dead skin removed etc?
autolytic - dressings etc
sharp debridement - scalpel/scissors
biological - maggots
surgical - removal of dead tissue under GA
why is zinc paste used in maggot treatment?
to protect surrounding skin from exudate caused
why is zinc paste used in maggot treatment?
to protect surrounding skin from exudate caused
which dressings heal ulcers?
none
compression heals ulcers
how should leg ulcers be washed?
warm tap water and soap substitute
because the wound isn’t sterile
how is venous dermatitis managed?
emollients
patch testing
topical steroids
compression
name 3 relevant diseases in management of leg ulcers
cardiovascular disease
diabetes
DVT
what shape is aimed for when padding and bandaging a leg
cone
how long do compression stocking last before they must be changed?
6 months
what is pyoderma gangrenosum?
autoinflammatory disorder causing al large ulcer
what are the signs and symptoms of vasculitis?
inflammation of blood vessels causing purpuric rash/pustules
sudden and painful
necrotic
