Skin Ulcers Flashcards
Types of skin ulcers?
Venous
Arterial
Neuropathic
Where are venous ulcers seen?
Below the knee
Inner leg
Just above the ankle
What do venous ulcers look like?
Red, yellow, fibrous tissue
Discharge if infected
Irregular borders
Warm to touch
Who gets venous ulcers?
Patients with history of leg oedema, DVT, varicose veins, sedentary lifestyle
Pathogenesis of venous ulcers?
A problem with venous circulation causes pressure in the veins to increase so they get damaged
Increased pressure + damaged veins causes skin to be fragile
A minor injury is likely to occur
Not enough immune cells or nutrients can get to the site so it forms and ulcer, and takes a long time to heal
Treatment of venous ulcer?
Compression, to try to restore the blood flow up the leg
Where do arterial ulcers occur?
On feet, helps, tips, between toes
Places where there is rubbing
What do arterial ulcers look like?
White, bluish, pale
Borders appear punched out
Very painful
Who gets arterial ulcers?
Patients with poor circulation to legs caused by atherosclerosis
Pathogenesis of arterial ulcers?
Reduction of blood flow to legs, tissue becomes ischaemic and minor injury to the skin results in a significant wound
It heals slowly due to lack of supply of immune cells and nutrients
Treatment of arterial ulcers?
NOT compression, will just make problem worse
Revascularisation
Where do neuropathic ulcers occur?
On pressure points on bottom of feet
What do neuropathic ulcers look like?
Pink, red, brown
Punched out
Surrounding skin is often calloused
Who gets neuropathic ulcers?
Diabetics who have developed peripheral neuropathy
People with neuropathy of a different cause
Pathogenesis of a neuropathic ulcer?
Lack of sensation - peripheral neuropathy
(in diabetes it is caused by excess glucose in blood which affect sensory nerves)
Lack of sensation means minor injuries to the feet go unnoticed and develop into ulcers
Damage can also occur from ill-fitting shoes, poor foot care
General management of skin ulcers?
Clean the wound: apply dressings to keep it sterile
- compression (V) or non-compression (A)
Treat any infection with antibiotics
Surgery: skin graft, revascularisation
Nutritional supplements to accelerate healing
What is ABPI?
Ankle brachial pressure index
Measures the ratio of BP at ankle and BP at arm
systolic BP at ankle / systolic BP at arm
A value above 1 means ankle BP is higher
A value below 1 means arm BP is higher
What do low and high ABPI results indicate?
Low = likely to be arterial ulcer, there is reduced blood flow at ankle
High = likely to be venous, there is normal or increased blood flow at ankle
What factors affect the ability of a wound to heal?
Oxygenation
Infection
Foreign body
Venous insufficiency
Also patient factors:
- disease
- medications
- immune system
- nutrition
What are the 4 stages of wound healing?
Haemostasis: platelets, fibrin, clot formation
Inflammation: immune cells, neutrophils, lymphocytes
Proliferation: re-epithelialisation
Remodelling: collagen remodelling, vascular maturation
