Leg Ulcers

Question 1

Where are venous ulcers typically seen?

Answer 1

Medial side of the leg, typically around the medial malleolus

Question 2

What is the cause of venous ulcers?

Answer 2

*Due to venous insufficiency
>when the valves are damaged and the blood backs up and pools in the vein (varicose veins)
>f there’s a problem with the circulation of blood in your leg veins, pressure inside the veins increases = tiny blood vessels become damages in skin making it fragile
>skin can easily break

Question 3

What factors increase your risk of developing venous ulcers?

Answer 3

• Obesity =increases pressure in leg veins
• Immobility =affects circulation
• Previous DVT =cause damage to valves
• Varicose veins
• Previous injury to leg
• previous surgery to leg
• increasing age

Question 4

What should be carried out when considering all ulcers?

Answer 4

ABPI to check for arterial insufficiency

Question 5

What is the management of venous ulcers?

Answer 5

• Compression bandaging (4 layer)

* Oral pentoxifyllin =peripheral vasodilator can improve healing rate

Question 6

Where to arterial ulcers commonly occur?

Answer 6

• Lateral side of the leg over bony prominences

* On toes and heels

Question 7

What is the presenting features with arterial ulcers?

Answer 7

• Cold with no palpable pulses
• Painful
• Areas of gangrene

Question 8

What is the investigation to confirm an arterial ulcer?

Answer 8

• ABPI confirms arterial insufficiency
• Buerger test
• Cap refill

Question 9

What is the management of arterial ulcers?

Answer 9

1. Lifestyles changes: stop smoking, diet, reduce cholesterol, control blood sugar
2. Wound care: keep clean and moist regularly changing dressings and physical/chemical debridement
3. Treat wound infection
4. Surgical intertventiong:
   >skin graft/flap
   >revascularisation bypass/angioplasty
   >amputation