Leg Ulcers Flashcards
what is a chronic leg ulcer?
an open lesion between the knee and the ankle joint which remained unhealed for at least 4 weeks
what type of leg ulcer are most common?
venous 60-80%
who gets leg ulcers?
1% of the UK population throughout their life time
prevalence increases with age
where are chronic venous leg ulcers usually cared for?
in primary care only some go to secondary care
what are the different types of leg ulcer?
venous arterial mixed arteriovenous vasculitic malignant inflammatory hydrostatic (dependent limb)
What are the distressing symptoms of a leg ulcer to the patient?
pain leakage smell infection social isolation
potential underlying causes of a leg ulcer?
diabetes anaemia skin cancer inflammatory disease smoking (increases risk of arterial ulcers)
Important parts of a leg ulcer history
mobility
pain
sleep disturbance
what is lipodermatosclerosis?
skin induration [woody, hardened, tethered skin] and hyperpigmentation of the legs that usually occurs in patients who have venous insufficiency
what is slough?
debris (dead skin and dead bacteria), it’s good to get rid of this - usually removed by compression for 6-8 weeks
what is granulation tissue?
new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process
what areas of the leg are indicative of a venous ulcer?
Gater area - the medial and lateral malleoli are common sites for venous ulcers
what is the management of venous dermatitis/ eczema?
emollients
patch testing
topical steroids
compression bandages/stockings
what does a venous ulcer look like?
tend to have a shallow edge
what does an arterial ulcer look like?
like a cliff edge,
lack of hair tends to indicate an arterial ulcer, these are referred to vascular [they’ll probably do angioplasty etc.]
what is used to assess the arterial system?
ABPI - measured using a blood pressure cuff and doppler
What are the different ABPI measures?
1.0 = normal
0.8 - 1.3 = compress [treatment]
< 0.8 = vascular disease
> 1.5 = calcification
what are the vasculitis symptoms?
painful
sudden onset
pupuric rash/pustules
necrotic
what is the aim of venous ulcer treatment?
heal ulcers by 12 weeks - dressings don’t heal the compression does
how are venous ulcers treated?
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
what vital signs need checked with leg ulcers?
pulse BP RR temp blood glucose tenderness pain
How do you debride the revitalised tissue for wound bed preparation?
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
what is a 4 layer compression bandage?
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
How can further leg ulcers be prevented?
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
