Lower Leg Ulcers Flashcards
name the different ulcers seen on the lower limbs
- venous leg ulcers
- marjolin’s ulcers
- arterial ulcers
- neuropathic ulcers
- pyoderma gangrenosum
what are the causes of venous ulcers?
- venous hypertension
- secondary to chronic venous insufficiency
- calf pump dysfunction
- neuromuscular disorders
what is the pathophysiology of venous ulcers?
due to capillary fibrin cuff or leucocyte sequestration
what are the features of venous insufficiency?
- oedema
- brown pigmentation
- lipodermatosclerosis
- eczema
where do venous ulcers typically form?
above the ankle
what are the features of venous ulcer?
- shallow
- oedema
- painless
what is deep venous insufficiency related to?
previous deep venous thrombosis
what is superficial venous insufficiency related to?
varicose veins
what is the investigation of choice for venous ulcers?
- doppler ultrasound = presence of reflux
- duplex ultrasound = anatomy/flow
what is the management of venous ulcer?
4 layer compression banding after exclusion of arterial disease or surgery
what is the indications for surgery in venous ulcers?
- failure to heal after 12 weeks
- > 10cm2 skin grafting may be needed
what is marjolin’s ulcer?
squamous cell carcinoma
where does marjolin’s ucler appear?
- at sites of chronic inflammation (e.g. burns, osteomyelitis)
- after 10-20 years
- lower limb
where do arterial ulcers typically occur?
toes and heels
what are the features of arterial ulcers?
- deep
- ‘punched-out’
- painful
what are the signs for arterial ulcer?
- may be areas of gangrene
- cold
- no palpable pulses
what is ABPI like in arterial ulcers?
low
where do neuropathic ulcers typically occur?
- over plantar surface of metatarsal head
- plantar surface of hallux
what neuropathic ulcer most commonly leads to amputations in diabetics?
plantar neuropathic ulcer
what is the cause of neuropathic uclers?
excessive pressure
what is the management of neuropathic ulcers?
cushioned shoes to reduce calleous formation
what is pyoderma gangrenosum associated with?
- IBD
- RA
where does pyoderma gangrenosum typically occur?
stoma sites
what does pyoderma gangrenosum look like?
erythematous nodules or pustules which ulcerate
