Leg Ulcers Flashcards
Define a chronic leg ulcer
An open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks
Most ulcers are?
Venous in nature
Name four causes of ulcers
Venous, arterial, rheumatoid or diabetic
Can also get mixed arterial and venous
What are venous ulcers due to?
Sustained venous hypertension
Name and explain six things venous ulcers might be associated with?
1- oedema of the lower legs
2- venous eczema (this can turn up on all parts of the body but originates on the legs)
3- brown pigmentation from haemosiderin (leakage of blood out into the capillary so get haemoglobin pigment in the skin itself)
4- varicose veins
5- lipodermatoclerosis (inflammation of the fat under the epidermis, feels like wood)
6- scarring white atrophy with telangiectasia
Management of venous ulcers?
Control pain
ABPI to check for aterial disease
Non-adherent dressing
De-sloughing agent if necessary e.g. hydrogel/ honey
4 layer compression bandaging- may need to increase pressure gradually if pain is a problem
Leg elevation
Once healed you need to prevent. Compression stockings should be used even after they’ve healed.
How do arterial ulcers usually present?
Higher up than venous ulcers OR on the foot as punched out painful lesions
What may there be a history of in someone with arterial ulcers?
Claudication, hypertension, angina or smoking
What may the leg be like if someone has an arterial ulcer
cold, pale, absent peripheral pulses, arterial bruits and loss of hair
What is slough?
Debris- dead skin and bacteria
Management of arterial ulcers?
ABPI, doppler to confirm
Keep the ulcer clean and covered, adequate analgesia and vascular reconstruction if appropriate.
Compression banadages must not be used
When do you swab an ulcer?
Only if you suspect infection- ie its painful, weeping, looks bad
Position of venous ulcers vs arterial
Venous is gaiter area (lower leg lateral and medial aspects) arterial is foot
Describe results of ABPI index
0.9-1.2 = normal
0.8-0.9 = mild
0.5-0.8= moderate
<0.5 = severe
If an ulcer isn’t healing what diagnosis would you consider?
BCC or SCC
