Limb Ulceration Flashcards
What are the causes of leg ulceration
- venous hypertension
- arterial disease
- neuropathic
- neoplastic
- vasculitis
- infection
- haematological
- drugs
- other
What are the different types of leg ulcers
- Venous ulcers
- arterial ulcers
- neuropathic ulcers
- pressure ulcers
- diabetic ulcers
- ischeaemic ulcers
What causes venous ulcers
- venous ulcers are the result of sustained venous hypertension in the superficial veins due to incompetent valves in the deep perforating veins or to previous deep vein thrombosis
What are venous ulcers associated with
- oedema of the lower legs
- venous eczema
- brown pigmentation from haemosiderin
- varicose veins
What is the management of venous ulcers
- high compression bandaging and leg elevation to reduce venous hypertension
- doppler studies should be done before compression to exclude significant arterial disease
- diuretics can reduce the oedema
- antibiotics only necessary for overt bacterial infection
- opiate pain medication if required
- ulcer dressings
Where are arterial ulcers
- present as punched out, painful ulcers higher up on the leg or on the feet
What is the clinical presentation of arterial ulcers
- clinically the leg is cold and pale
- absent peripheral pulse
- arterial bruits
- loss of hair
What is the management of arterial ulcers
- keep the ulcer clean and covered
- adequate analgesia and vascular reconstruction if appropriate
What causes neuropathic ulcers
- tend to be over pressure areas of the feet such as the metatarsal heads owing to repeated trauma
- most commonly found in diabetics due to peripheral neuropathy
what causes arterial ulcers (ischaemic ulcers)
Arterial leg ulcers occur as a result of reduced arterial blood flow and subsequent tissue perfusion.
Three mechanisms involved in the pathophysiology :
- (a) extramural strangulation,
- (b) mural thickening or accretion
- (c) intramural restriction of blood flow
What causes diabetic ulcers
Diabetic ulcers are most commonly caused by: poor circulation. high blood sugar (hyperglycemia) nerve damage
What is the management of pressure ulcers
- bed rest with pillows and fleeces to keep pressure of bony areas and to prevent friction
- air filled cushions for patients in wheelchairs
- special pressure relieving mattresses and beds
- regular turning but avoidance of pressure on hips
- adequate nutrition
- treatment of underlying cause
How can you prevent ulcers
- identify at risk patients
- use of the Norton scale to identify those who are most at risk
Primary prevention
- loose weight
- compression stockings
- treat underlying cause such as varicose veins
if the skin ulcer is superior to the medial malleolus what type of ulcer is it likely to be
- venous ulcer
If the skin ulcer is around the sacrum, greater trochanter, or heel what type of ulcer is it likely to be
- pressure sore (decubitus ulcer)
