Skin Ulcers Flashcards
Ulcer definition
abnormal breaks in an epithelial surface
most common type?
venous
what causes venous ulcers?
sustained venous hypertension in the superficial veins from incompetent valves in deep or perforating veins or from previous DVT
Venous ulcer location
on lower leg in a triangle above the ankles
Venous ulcer associations
oedema of the lower legs
venous eczema
brown pigmentation
Venous ulcer presentation
relatively painless unless infected
Venous ulcer path
congestion –> shunting of pressure to superficial veins –> VVs –> venous pooling + venous stasis –> epidermis metabolism not supported –> epidermis spontaneously sloughed off or knocked off by mild trauma
Examination of ulcers
site, temp, number, surface area, depth, edge, base, discharge etc.
Arterial ulcers cause
failure of arterial supply to that region
may be Hx of claudication, HT, angina or smoking
(PAD)
Diagnostic tests for arterial ulcers
Doppler US studies. Low ABPI
Arterial ulcer presentation
leg is cold + pale
punched-out painful ulcers higher up on leg or on feet
pain relieved when legs lowered to the floor
Neuropathic ulcer location
over pressure areas of the feet e.g. metatarsal heads, owing to repeated trauma
Neuropathic ulcer cause
peripheral neuropathy (diabetics) leprosy in developing countries
Why biopsy?
to assess for vasculitis or malignant change in established ulcer
Tx venous ulcer
4-layer compression bandaging
Negative pressure wound therapy
Surgery, larval therapy + hydrogels to deride sloughy necrotic tissue
Painkillers, support stockings
