Leg Ulcers

Question 1

Pathophysiology of leg ulcers

Answer 1

• Arterial ulcers occur due to poor blood supply to the skin due to peripheral arterial disease
• Venous ulcers occur due to pooling of blood and waste products in the skin secondary to venous deficiency
• Small wounds cannot heal due to poor blood supply and gets progressively larger and also more difficult to heal

Question 2

Features of arterial ulcers

Answer 2

• Punched out appearance
• Lateral location
• Absent pulses
• Pallor
• Tend to be smaller
• More regular boarder
• Grey colour due to poor blood supply
• Less likely to bleed
• More painful than venous ulcers
• Pain at night when legs elevated
• Pain worse on elevating the leg, improved by hanging

Question 3

Features of venous ulcers

Answer 3

• Shallow and superficial appearance
• Medial location
• Oedematous flushed skin
• Hyperpigmentation to skin
• Varicose eczema
• Tend to be larger
• Irregular boarder
• More likely to bleed
• Pain relieved by elevation and worse on hanging

Question 4

Management of leg ulcers

Answer 4

• Treating underlying cause
• Good wound care
  
  • Debridement
  • Cleaning
  • Dressing
  • Antibiotics where infected
• Tissue viability nurse and district nurse input
• Plastic surgery input in severe ulcers
  
  • Skin grafts in severe and appropriate cases