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Dermatology > Leg Ulcers > Flashcards

Leg Ulcers Flashcards

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1
Q

Which groups are commonly affected by leg ulcers

A

The elderly - getting more prevalent with ageing population
Diabetics
Immobile people

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2
Q

Who cares for leg ulcers

A

80% in community - GP and nurses
12% specialist - derm and surgeon
5% in patients

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3
Q

What might you have to do before treating with a compression bandage

A

Treat the pain
Often this is the biggest issue affecting the patient
They sometimes cannot tolerate the bandages

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4
Q

What is venous dermatitis

A

Dry, scaly skin that occurs secondary to venous insufficiency
Blood isn’t providing enough nutrients etc as it is static

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5
Q

Where do venous ulcers usually appear

A

In the gator area

This is in the lower leg - mid calf/shin down to malleolus

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6
Q

Where do arterial ulcers usually appear

A

Higher up on the calf or shin

Often on the foot/toes/pressure areas

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7
Q

What type of ulcers may be found on the heel

A

Pressure ulcers

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8
Q

Where on the foot would diabetic ulcers be found

A

Toes

Can occur elsewhere

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9
Q

What is slough

A 
Debris, combination of dead cells, bacteria and exudate 
Seen on the surface of ulcers 
Appears yellowish/green
Not dangerous but can impair healing 
Should be debrided
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10
Q

What is the classic appearance of an arterial ulcer

A

Sharp edge
Punched out appearance
May see tendon

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11
Q

What other signs would be seen on a leg with an arterial ulcer

A 
Hairless 
Pale 
Cold 
Poor peripheral pulses 
Due to poor blood supply
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12
Q

What is vasculitis

A

inflammation of the blood vessels
Group of conditions with different presentations
Can be caused by, high fat, poor blood supply, vasoconstrictor drugs, stasis etc

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13
Q

What is the cutaneous presentation of vasculitis

A

Painful
Sudden onset
Purpuric rash/pustules
Necrotic

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14
Q

What investigations would you do for a leg ulcer

A 
ABPI - carried out on everyone to assess vascular disease and sufficiency
Wound swab - ONLY if sign of infection 
Bloods - FBC, LFT, U&E to check healing 
Patch testing to treatment options 
Duplex scan if indicated
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15
Q

How do you treat a venous ulcer

A

COMPRESSION - 4 layer bandaging
control pain
De-slough if needed
Leg elevation

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16
Q

How should a compression bandage be applied

A

With graduated compression
Tighter above ankle then decrease as you work up - force blood back up leg
Pad leg to cone shape to assist
Changed weekly, or as required

17
Q

What is the function of a dressing

A

Just stop bandage sticking to open wound

They DO NOT heal the wound

18
Q

How do you prep the wound bed for healing

A

Need to remove necrotic tissue
Rehydration with hydrogel or honey - autolytic
Sharp debridement - cut away dead areas with scalpel/scissors
Surgical
Larvae therapy - apply maggots

19
Q

How do you measure ABPI

A 
Take BP on each arm and each ankle 
Calculate the ratio of highest pressure obtained from the ankle to highest brachial pressure of the two arms
Normal = 0.8 to 1.3 
< 0.8 - vascular disease
>1.5 calcification
20
Q

List causes of poor wound healing

A 
Infection
Poor arterial supply
Impaired venous return
Repeated trauma / friction
Poor nutritional state
Underlying systemic disease eg diabetes, anaemia
21
Q

What is the definition of a chronic wound

A

Present for >4 weeks and not healing normally

Open lesion

22
Q

Why are diabetics prone to feet ulcers

A

Neuropathy and microvascular disease
Numb feet means trauma goes un-noticed
Poor circulation delays healing

23
Q

What causes a venous ulcer

A

Leaky valves (insufficiency) cause high back pressure in leg veins (varicose veins)

This results in stasis and unhealthy skin overlying the area

24
Q

What are the 3 stages of wound healing

A

Inflammation, proliferation and tissue remodeling

25
Q

What causes a pressure sore

A

Prolonged pressure over bony area
Friction from bedding / clothing
Irritation from sweat / blood / urine / faeces
Lack of blood flow

All contribute to erosion and ulceration of the skin

26
Q

What is lipodermatosclerosis

A

Hardening of the skin caused by inflammation

Skin change of the lower legs that often occurs in patients who have venous insufficiency

27
Q

How do venous ulcers appear

A

Superficial ulceration

Signs of venous disease such as varicose veins, haemosiderin staining, lipodermatosclerosis

28
Q

How do you treat an arterial ulcer

A 
Pain relief
Lifestyle changes eg smoking
Aspirin
Treat infections
Soffban and crepe bandages toe to knee(reduce oedema)
Vascular surgery if indicated
29
Q

What is a minced micrograft

A

Used for accelerating healing of clean ulcers
An ellipse of skin is taken from the abdomen, the site sutured, then the ellipse diced up and tissue spread on to ulcer site

Dermatology (14 decks)

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