Leg ulcers

Question 1

Answer 1

Venous ulcer

• painful, worse on standing
• History of varicose veins, DVT
• Warm skin, normal peripheral pulses, oedema, haemosiderin , lipodermatosclerosis
• Normal Ankle/Brachial Pressure Index (0.8-1)
• Compression bandaging (after excluding arterial insufficiency)

Question 2

Answer 2

Arterilal ulcer

• Painful espeicially at night, worse when legs are elevated
• History of aterial disease e.g. atherosclerosis
• Cold skin, weak or absent peripheral pulses, shiny pale skin, loss of hair
• ABPI <0.8 - arterial insuffiency
• Doppler studies and angiography
• Vascular reconstruction
• Compression banding is contraindicated

Question 3

Answer 3

Neuropathic ulcer

• Painless, abnormal sensation
• History of diabetes or neurological diseae
• Warm skin, normal peripherial pulses, peripheral neuropathy
• ABPI <0.8 = neuroischaemic, X-ray to rule out osteomyetlitis
• Wound debridement, regular repositioning, foot wear and good nutrition