Leg Ulcers Flashcards

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1
Q

what is a chronic leg ulcer?

A

an open lesion between the knee and the ankle joint which remained unhealed for at least 4 weeks

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2
Q

what type of leg ulcer are most common?

A

venous 60-80%

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3
Q

who gets leg ulcers?

A

1% of the UK population throughout their life time

prevalence increases with age

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4
Q

where are chronic venous leg ulcers usually cared for?

A

in primary care only some go to secondary care

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5
Q

what are the different types of leg ulcer?

A
venous 
arterial 
mixed arteriovenous 
vasculitic 
malignant 
inflammatory 
hydrostatic (dependent limb)
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6
Q

What are the distressing symptoms of a leg ulcer to the patient?

A
pain 
leakage 
smell 
infection 
social isolation
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7
Q

potential underlying causes of a leg ulcer?

A
diabetes 
anaemia 
skin cancer 
inflammatory disease 
smoking (increases risk of arterial ulcers)
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8
Q

Important parts of a leg ulcer history

A

mobility
pain
sleep disturbance

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9
Q

what is lipodermatosclerosis?

A

skin induration [woody, hardened, tethered skin] and hyperpigmentation of the legs that usually occurs in patients who have venous insufficiency

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10
Q

what is slough?

A

debris (dead skin and dead bacteria), it’s good to get rid of this - usually removed by compression for 6-8 weeks

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11
Q

what is granulation tissue?

A

new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process

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12
Q

what areas of the leg are indicative of a venous ulcer?

A

Gater area - the medial and lateral malleoli are common sites for venous ulcers

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13
Q

what is the management of venous dermatitis/ eczema?

A

emollients
patch testing
topical steroids
compression bandages/stockings

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14
Q

what does a venous ulcer look like?

A

tend to have a shallow edge

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15
Q

what does an arterial ulcer look like?

A

like a cliff edge,

lack of hair tends to indicate an arterial ulcer, these are referred to vascular [they’ll probably do angioplasty etc.]

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16
Q

what is used to assess the arterial system?

A

ABPI - measured using a blood pressure cuff and doppler

17
Q

What are the different ABPI measures?

A

1.0 = normal
0.8 - 1.3 = compress [treatment]
< 0.8 = vascular disease
> 1.5 = calcification

18
Q

what are the vasculitis symptoms?

A

painful
sudden onset
pupuric rash/pustules
necrotic

19
Q

what is the aim of venous ulcer treatment?

A

heal ulcers by 12 weeks - dressings don’t heal the compression does

20
Q

how are venous ulcers treated?

A

Check vital signs
Control pain
ABPI
Non-adherent dressing
De-sloughing agent if needed e.g. hydrogel/honey
Wound bed preparation, removal of devitalised tissue by debridement
Only swab if signs of clinical infection
4 layer compression bandaging
leg elevation ideally above hip height

21
Q

what vital signs need checked with leg ulcers?

A
pulse 
BP
RR
temp
blood glucose 
tenderness 
pain
22
Q

How do you debride the revitalised tissue for wound bed preparation?

A

Autolytic = the use of dressings to create moist wound environment and hydrate necrotic tissue/eschar [dead skin] - hydrogel/honey
Sharp debridement = with scalpel/scissors
Biological = larvae therapy [i.e. maggots]
Surgical = under general anaesthetic

23
Q

what is a 4 layer compression bandage?

A

cone shape
changed weekly/as required
may need to increase compression gradually if pain is a problem
graduated compression basically acts like a muscle pump to push blood up the way

24
Q

How can further leg ulcers be prevented?

A

60% recurrence rate at 1 year if no prevention:
compression stockings
[class 1 = weak,
class 3 = strong,
most patients = class 2,
compression stockings last for 4-6 months], emollients

25
Q

how to clean a leg ulcer

A

warm tap water and soap substitute