Leg Ulcers Flashcards
Which groups are commonly affected by leg ulcers
The elderly - getting more prevalent with ageing population
Diabetics
Immobile people
Who cares for leg ulcers
80% in community - GP and nurses
12% specialist - derm and surgeon
5% in patients
What might you have to do before treating with a compression bandage
Treat the pain
Often this is the biggest issue affecting the patient
They sometimes cannot tolerate the bandages
What is venous dermatitis
Dry, scaly skin that occurs secondary to venous insufficiency
Blood isn’t providing enough nutrients etc as it is static
Where do venous ulcers usually appear
In the gator area
This is in the lower leg - mid calf/shin down to malleolus
Where do arterial ulcers usually appear
Higher up on the calf or shin
Often on the foot/toes/pressure areas
What type of ulcers may be found on the heel
Pressure ulcers
Where on the foot would diabetic ulcers be found
Toes
Can occur elsewhere
What is slough
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
What is the classic appearance of an arterial ulcer
Sharp edge
Punched out appearance
May see tendon
What other signs would be seen on a leg with an arterial ulcer
Hairless Pale Cold Poor peripheral pulses Due to poor blood supply
What is vasculitis
inflammation of the blood vessels
Group of conditions with different presentations
Can be caused by, high fat, poor blood supply, vasoconstrictor drugs, stasis etc
What is the cutaneous presentation of vasculitis
Painful
Sudden onset
Purpuric rash/pustules
Necrotic
What investigations would you do for a leg ulcer
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
How do you treat a venous ulcer
COMPRESSION - 4 layer bandaging
control pain
De-slough if needed
Leg elevation
How should a compression bandage be applied
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
What is the function of a dressing
Just stop bandage sticking to open wound
They DO NOT heal the wound
How do you prep the wound bed for healing
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
How do you measure ABPI
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
List causes of poor wound healing
Infection Poor arterial supply Impaired venous return Repeated trauma / friction Poor nutritional state Underlying systemic disease eg diabetes, anaemia
What is the definition of a chronic wound
Present for >4 weeks and not healing normally
Open lesion
Why are diabetics prone to feet ulcers
Neuropathy and microvascular disease
Numb feet means trauma goes un-noticed
Poor circulation delays healing
What causes a venous ulcer
Leaky valves (insufficiency) cause high back pressure in leg veins (varicose veins)
This results in stasis and unhealthy skin overlying the area
What are the 3 stages of wound healing
Inflammation, proliferation and tissue remodeling
What causes a pressure sore
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
What is lipodermatosclerosis
Hardening of the skin caused by inflammation
Skin change of the lower legs that often occurs in patients who have venous insufficiency
How do venous ulcers appear
Superficial ulceration
Signs of venous disease such as varicose veins, haemosiderin staining, lipodermatosclerosis
How do you treat an arterial ulcer
Pain relief Lifestyle changes eg smoking Aspirin Treat infections Soffban and crepe bandages toe to knee(reduce oedema) Vascular surgery if indicated
What is a minced micrograft
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
