Leg Ulcers Flashcards
What is the definition of a CHRONIC leg ulcer?
open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks.
What type of leg ulcer is most common?
60-80% of leg ulcers are venous in nature
What other forms of leg ulcers can be developed by patients?
22% arterial disease
9% rheumatoid arthritis (due to defective neuropathy)
5% diabetic (due to defective neuropathy)
Mixed arterial venous disease 10-20%
The prevalence of leg ulcers increases with age. True/False?
True
=> will become more of a problem with the ageing population
Who is responsible for treatment of leg ulcers?
> 80% of chronic venous leg ulcers cared for in the community
12% community and secondary care
5% in-patient treatment
What distressing symptoms may leg ulcers cause?
pain leakage smell infection social isolation
How much does it roughly cost the NHS per year to treat 1 leg ulcer?
£1500 per annum to treat 1 leg ulcer
Why do leg ulcers cost so much to treat?
By time patient presents, the degree of disease is extensive:
Delay in full assessment and diagnosis
Delay in ABPI’s or none at all
Delay in commencing compression
Lack of confidence in compression application
Expensive dressings and inappropriate use
What other causes should you consider when examining a leg ulcer?
Venous Arterial (or mixed arterio-venous) Vasculitic Malignant Inflammatory “Hydrostatic” - dependant limb
What is the order of assessment in a patient with a leg ulcer?
Patient
leg
ulcer
What background factors should you consider about the patient before thinking about their leg and ulcer?
Current medication Social circumstances Smoker past or present Mobility Pain Sleep disturbance
What is Lipodermatosclerosis and why is it important in the formation of a leg ulcer?
A sclerotic reaction to venous hypertension:
skin thickens
insufficient blood supply
more likely to form ulcer if trauma occurs
Why does venous dermatitis occur?
the non-nutritious venous blood irritates the skin
What ulcers can be found in the “gaiter area” ?
Venous
What type of ulcers are commonly found further up the calf?
Arterial OR Skin cancers
Where can pressure ulcers be found?
On the heels
patients get these if bedbound for significant amount of time
What type of ulcers are common in the foot?
Diabetic due to lack of feeling
What is slough?
skin debris and dead bacteria on top of ulcerated tissue
often yellow in colour
What disease is Necrobiosis Lipoidica linked to?
Diabetes
What are the most common causes of vasculitis?
Infection or drugs
What is vasculitis?
group of disorders in which there are inflamed blood vessels
e.g. capillaries, arterioles, venules and lymphatics.
Describe how vasculitis can present clinically
Painful
Sudden onset
Purpuric rash/pustules
Necrotic
How would an arterial ulcer usually appear?
Hairless leg Cool/pale leg Painful Sharp edge Punched out lesion Can sometimes see tendon (due to ulcer depth)
Describe the difference between a normal and abnormal ABPI
<0.8 = vascular disease ~1 = normal >1.5 = calcification **often noise is continually heard on Doppler as arteries wont compress due to extensive calcification**
What differentials must be considered if a suspected venous ulcer is not healing with compression?
Basal cell carcinoma
Squamous cell carcinoma
When would you swab an ulcerated wound?
Only if showing clinical signs of infection
=> ulcer increasingly painful/exudate/malodour/
enlarging
At what point would a leg ulcer patient benefit from patch testing?
If they become allergic to previous ulcer treatments
eg. Bandages, dressings, creams
What agents can be used to get rid of slough on a wound?
hydrogel
honey
Maggot therapy
Leg elevation can help in the management of venous ulcers. Where should the leg be raised to?
Above hip height
How are compression stockings graded?
Class 1(weak) to class 3 (strong).
What shape should compression bandages aim to create on the leg?
Leg padded to a cone shape
How often should a compression bandage be changed?
Weekly
How long should it take to heal a venous ulcer through compression?
12 weeks
if not healed by then consider other differentials
Can venous ulcers be healed by dressings?
No, the compression is what heals the ulcers
How are wound beds usually prepped for further therapy?
Autolytic: The use of dressings to create moist wound environment and hydrate necrotic tissue
Sharp debridement: With scalpel or scissors
Biological: larvae therapy
Surgical: under general anaesthetic
What other component is used as a barrier around the perimeter of the wound to stop it leaking during larvae therapy?
Zinc Oxide (ZnO)
What is slough?
a) Healthy skin
b) Active infection
c) Skin debris and dead bacteria
d) Granulation tissue
C
How can slough be removed?
a) Compression bandaging
b) Hydrogels
c) Manual debridement
d) All of the above
D
Which ulcers should be swabbed?
a) All ulcers
b) Sloughy ulcers
c) Painful ulcers
d) Only those showing signs of clinical infection
D
How should a leg ulcer be cleaned?
a) Warm tap water and soap substitute
b) Sterile saline solution
c) Hibiscrub
d) They shouldn’t be washed
A
How should venous dermatitis be managed?
a) Apply regular emollients
b) Consider patch testing
c) Topical steroids
d) Compression bandages or stockings
e) All of the above
E
Which of the following could be the cause of a non-healing leg ulcer?
a) Skin cancer
b) Inflammatory skin disease
c) Poor hygiene
d) a and b
D
Which of these conditions are important in the management of leg ulcers?
a) Cardiovascular disease
b) Diabetes
c) Deep venous thrombosis
d) All of the above
D
Why is ABPI performed?
a) To check for DVT
b) To examine the varicose veins prior to surgery
c) To assess the arterial system
d) To measure oxygen levels in the feet
C
What shape are you aiming for when padding and shaping a leg prior to bandaging?
a) Oval
b) Rectangle
c) Cone
d) Triangle
C
What is the most important therapy in healing venous leg ulcers?
a) Dressings
b) Antibiotics
c) Skin grafts
d) Compression
D
Once a venous ulcer is healed, what should the patient be advised to do?
a) Nothing
b) Use regular emollient
c) Wear appropriate strength compression stockings
d) b and c
D
How long do compression stockings last?
4-6 months
Forever
2 months
12 months
A
