Limb Ulceration

Question 1

What is the cause of venous limb ulceration?

Answer 1

1. Mostly due to venous HTN secondary to chronic venous insufficiency (deep/superficial).
2. Deep related to DVT, superficial related to varicose veins.

Question 2

What are the clinical features of venous limb ulceration?

Answer 2

1. Features of venous insufficiency - oedema, hemosiderin, lipodermatosclerosis
2. Above ankle and painless

Question 3

What are the risk factors for venous limb ulceration?

Answer 3

VV, DVT, venous insufficiency, AV fistulae, obesity, fractures.

Question 4

How is suspected venous limb ulceration investigated?

Answer 4

ABPI to rule out poor arterial flow in non-healing ulcers

Question 5

What is the management for venous limb ulceration?

Answer 5

1. Charing cross 4-layer compression bandaging

2. Skin grafting if fails to heal after 12 weeks or >10cm^2

Question 6

What are the clinical features of arterial limb ulceration?

Answer 6

1. Occurs on toes and heel
2. Painful, may be areas of gangrene
3. Cold, no palpable pulses
4. ABPI <0.9

Question 7

What is the treatment for arterial limb ulceration?

Answer 7

Antiplatelet, statin, surgical revascularisation.

Question 8

What is the typical site of neuropathic limb ulceration?

Answer 8

Commonly over plantar surface of metatarsal head and plantar surface of hallux, due to pressure.

Question 9

What is the treatment for neuropathic limb ulceration?

Answer 9

Cushioned shoes to reduce callous formation.

Question 10

Who develops pressure limb ulceration and where?

Answer 10

1. Patient unable to move parts of body due to illness, advancing age, or paralysis.
2. Typically over bony prominences such as heel or sacrum.

Question 11

What are the risk factors for developing pressure limb ulceration?

Answer 11

Malnutrition, incontinence, immobility, pain (less movement).

Question 12

What is the scoring system for pressure limb ulceration?

Answer 12

Waterlow score:

1. Grade 1 - non-blanchable erythema of intact skin, discolouration, warmth, oedema, induration, hardness.
2. Grade 2 - partial thickness skin loss involving epidermis/dermis/both, superficial ulcer (abrasion/blister)
3. Grade 3 - full thickness skin loss, damage to/necrosis of subcutaneous tissue.
4. Grade 4 - extensive destruction, tissue necrosis, damage to muscle/bone/supporting structures.

Question 13

What is the management of pressure limb ulceration?

Answer 13

1. Pressure relieving mattress and cushions.
2. Frequent repositioning
3. Encourage moist wound environment with hydrocolloid dressings.
4. Discourage wound swabs as most are colonised.
5. Refer to tissue viability nurse.
6. Antibiotics only if evidence of infection (e.g. surrounding cellulitis).