Leg Ulcers

Question 1

Define an leg ulcer

Answer 1

Open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks

Question 2

What are the different types of leg ulcer? Which is most common?

Answer 2

• venous (60-80%)
• arterial
• rheumatoid
• diabetic

Question 3

How does a venous leg ulcer present?

Answer 3

• dermal haemosiderin from red blood cells
• eczema
• venous flares
• lipodermatosclerosis
• hyper pigmentation
• hyperkeratosis

Question 4

Where are venous leg ulcers commonly found?

Answer 4

Gaiter area

Question 5

How is a venous leg ulcer treated?

Answer 5

Aim to control pain, dress, de-slough, elevate & compress

Question 6

What is the typical presentation of an arterial ulcer?

Answer 6

punched out with slough (debris), lack of hair on leg, cold and pale toes

Question 7

Name the necrotising skin condition found in diabetics associated with arterial ulcers

Answer 7

Necrobiosis Lipoidica

Question 8

Name the skin condition found in IBD/autoimmune conditions

Answer 8

Pyoderma gangrenosum

Question 9

What is vasculitis?

Answer 9

Inflammation of blood vessels - painful, sudden onset, purpuric rash with pustules

Question 10

What investigations need to be done in an arterial leg ulcer?

Answer 10

• ABPI
• Blood test
• Wound swab if infection suspected
• Patch Test (dressing/zinc allergy)

Question 11

State the values of a normal ABPI

Answer 11

0.8 - 1.3
>1.5 - calcification
<0.8 - vascular disease

Question 12

How is an arterial leg ulcer treated?

Answer 12

Compression - 40 - 25mmHg at knee aim to heal in 12 weeks

Wound Bed - dressings, sharp debridement, maggots, surgical debridement