Leg Ulcers

Question 1

Define an ulcer?

Answer 1

A skin break with a loss of the epidermis and part or all of the dermis.

Question 2

Describe the features of venous ulcers?

Answer 2

• Large
• Superficial
• Gaiter area
• Signs of chronic venous disease
• May or may not be painful

Question 3

Describe the aetiology of venous insufficiency?

Answer 3

Failure of calf pump mechanism, aka immobility can cause venous insufficiency.

Incompetent valves

Question 4

What are the features of venous insufficency?

Answer 4

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

Question 5

What are some of the complications of venous ulceration?

Answer 5

Superficial infection

Cellulitis

Lymohoedema

Contact dermatitis from dressings and ointments

(assciated eczema - venous eczema)

Question 6

Describe the features of arterial ulcers?

Answer 6

• Punched out
• Necrotic
• Over pressure areas
• Painful
• Symptoms of arterial disease

Question 7

What is an ABPI and what are the different degrees depending on the score?

Answer 7

Ankle Brachial Pressure Index

Assess the the difference in bp betwen the ankle and arm. (

Where PLeg is the systolic blood pressure of dorsalis pedis or posterior tibial arteries

and PArm is the highest of the left and right arm brachial systolic blood pressure)

• 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

Question 8

What are the treatments for Venous ulcers?

Answer 8

Compression, dressings, reducing risk of infection.

Superficial venous surgery can be done.

In severe cases skin grafting.

Question 9

What are the treatments of arterial ulcers?

Answer 9

Conservative: Increase walking to encourage collateralls and lifestyle changes (STOP SMOKING)

Angioplasty.

Bypass surgery.

Question 10

When should you consider using larvae therapy?

Answer 10

As a debridement agent as the larvae only eat necrotic skin it therefore removes this skin reducing infection risk.

Question 11

Where do neuropathic ulcers most commonly occur, what it the most common joint aetilogy?

Answer 11

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.

Question 12

What are the causes of vasculitic leg ulcers?

Answer 12

• 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)

Question 13

Name the type of ulcer?

Answer 13

Arterial

Punched out and necrotic

Question 14

Name the type of ulcer?

Answer 14

Neuropathic ulcer

Question 15

Name the type of ulcer?

Answer 15

Vasculitic ulcer

Question 16

Name the type of ulcer?

Answer 16

Venous

Question 17

Name the condition and what is associated with?

Answer 17

Atrophie Blanche

Venous Insufficicency

Question 18

Name the condition and what it is assocaited with?

Answer 18

Lipodermatosclerosis

Venous Insufficiency