Lower Leg Ulcers

Question 1

name the different ulcers seen on the lower limbs

Answer 1

• venous leg ulcers
• marjolin’s ulcers
• arterial ulcers
• neuropathic ulcers
• pyoderma gangrenosum

Question 2

what are the causes of venous ulcers?

Answer 2

• venous hypertension
• secondary to chronic venous insufficiency
• calf pump dysfunction
• neuromuscular disorders

Question 3

what is the pathophysiology of venous ulcers?

Answer 3

due to capillary fibrin cuff or leucocyte sequestration

Question 4

what are the features of venous insufficiency?

Answer 4

• oedema
• brown pigmentation
• lipodermatosclerosis
• eczema

Question 5

where do venous ulcers typically form?

Answer 5

above the ankle

Question 6

what are the features of venous ulcer?

Answer 6

• shallow
• oedema
• painless

Question 7

what is deep venous insufficiency related to?

Answer 7

previous deep venous thrombosis

Question 8

what is superficial venous insufficiency related to?

Answer 8

varicose veins

Question 9

what is the investigation of choice for venous ulcers?

Answer 9

• doppler ultrasound = presence of reflux
• duplex ultrasound = anatomy/flow

Question 10

what is the management of venous ulcer?

Answer 10

4 layer compression banding after exclusion of arterial disease or surgery

Question 11

what is the indications for surgery in venous ulcers?

Answer 11

• failure to heal after 12 weeks
• > 10cm2 skin grafting may be needed

Question 12

what is marjolin’s ulcer?

Answer 12

squamous cell carcinoma

Question 13

where does marjolin’s ucler appear?

Answer 13

• at sites of chronic inflammation (e.g. burns, osteomyelitis)
• after 10-20 years
• lower limb

Question 14

where do arterial ulcers typically occur?

Answer 14

toes and heels

Question 15

what are the features of arterial ulcers?

Answer 15

• deep
• ‘punched-out’
• painful

Question 16

what are the signs for arterial ulcer?

Answer 16

• may be areas of gangrene
• cold
• no palpable pulses

Question 17

what is ABPI like in arterial ulcers?

Answer 17

low

Question 18

where do neuropathic ulcers typically occur?

Answer 18

• over plantar surface of metatarsal head
• plantar surface of hallux

Question 19

what neuropathic ulcer most commonly leads to amputations in diabetics?

Answer 19

plantar neuropathic ulcer

Question 20

what is the cause of neuropathic uclers?

Answer 20

excessive pressure

Question 21

what is the management of neuropathic ulcers?

Answer 21

cushioned shoes to reduce calleous formation

Question 22

what is pyoderma gangrenosum associated with?

Answer 22

• IBD
• RA

Question 23

where does pyoderma gangrenosum typically occur?

Answer 23

stoma sites

Question 24

what does pyoderma gangrenosum look like?

Answer 24

erythematous nodules or pustules which ulcerate