Leg Ulcers Flashcards
What is a leg ulcer?
An open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks
What are the causes of leg ulcers?
Venous (60-80%) Arterial disease Rheumatoid arthritis Diabetic Mixed arterial and venous disease Malignancy Inflammatory
How do venous ulcers present?
Champagne bottle appearance of leg
Varicose veins
Haemosiderin staining
Venous dermatitis - itchy, localised
What are the methods of treatment for venous ulcers?
Compression
Steroids
Healing dressing
What is the presentation of arterial ulcers?
Extremely painful Red, hot Leg will be pale Will need to get up during night and walk to alleviate pain Can only elevate legs for a short time
What is the treatment for arterial ulcers?
Clean
Steroid
Analgesia
Dont compress
When are necrobiosis lipoidica ulcers seen?
In diabetic patients
What is the presentation of necrobiosis lipoidica ulcers?
Diabetic patients
Very painful
Young patients (20s and 30s)
Patchy
What is the treatment for necrobiosis lipoidica ulcers?
Compression
May need other management e.g. medication, light therapy
What is the presentation of pyoderma gangrenosum?
Usually due to trauma (e.g. biopsy)
Not healed normally
Discoloured around the edge
Inflammatory
What is the presentation of a vasculitis ulcer?
Purpuric rash/pustules Can coalesce into one big ulcer Very painful Sudden onset Necrotic
What is the treatment of a vasculitis ulcer?
First manage vasculitis and use dressings
Then compression
What investigation should be done for ulcers?
ABPI
Wound swab if ulcer is increasingly painful/exudate/malodour/enlarging
Bloods
Patch testing to previous ulcer treatments
Duplex scan if indicated
What is the purpose of ABPI?
To establish if there is arterial disease
What do different ABPI results mean?
1 - normal 0.8-1.3 - within normal limits, can compress >1.5 calcification <0.8 - vascular disease <0.6 - arterial component to disease
