Leg ulcers Flashcards
definition of a leg ulcer
non-healing open lesion present for >4 weeks in gaitor area (between knee + ankle)
what are the different types of leg ulcer
venous
arterial
neuropathic (diabetic)
most common ulcer
venous
pathophysiology of a venous ulcer
venous insufficiency – fluid leaks from veins/capillaries – oedema + deposition of plasma proteins + inflammatory mediators – hypoxia + damage to local tissues – ulceration
appearance of venous ulcer + surrounding skin
superficial ulcer, rough edge + redness
purple/brown (haemosidrin) discolouration
lipodermatosclerosis
ankle flare
venous eczema/varicose veins may be present
what is lipodermatosclrosis
inflammation of subcutaneous fat causing pain and constriction of soft tissue
most common site for venous ulcer
medial leg along great saphenous vein
normal ABPI measurement
0.8 - 1.3
what ABPI measurement suggests vascular disease
<0.8
what ABPI measurement suggests calcification (arterial disease)
> 1.5
treatment of venous ulcer
wound debridement compression - reverses venous insufficiency. - 40 mmHg at ankle, 25mmHg below knee - aims to heal by 12 weeks limb elevation to aid drainage
what is used to protect surrounding skin from ulcer exudate
zinc paste
what drugs can delay healing of venous ulcers
PPIs
nifedipine
signs of arterial disease in the leg
hairless
pale
cold to touch
unable to palpate pulses
appearance of arterial ulcer
deep + punched out, clear edge
usually found on pressure points e.g. foot + toes
