Skin Ulcers Flashcards
Ulcer def
Open sore from loss of epidermis and some of dermis
Arterial ulcers
Dry skin and hair loss to ulceration and gangrene
Tips of toes or base of heel
Painful
Gray/yellow fubrotic base
Lead to infection and amputation
Nonpalb pedal pulses
PAD risk factors
Diabetes and smoking are big ones
Sx of PAD
Cold extrimities
Claudication
Cut findings in PAD
Hair loss
Coldness
Cyanosis
Dependent rubor
Comps of PAD
Limb loss due to progressive, severe ischemia or infection
Suerimposed infection - need ABs and wound debridement
Management of arteial ulcers
Vasc surgery to try to revascularize
Eval for infection
avoid debridement until blood flow occurs
Chronic venous insufficiency
Venous ulcers from valve dysfunction in lower extremities
Longstanding dz
Shallow, irregular, red based and located below knee (typically on medial ankle)
Chronic venous insufficnecy clinical findings
Swelling
Varicose veins
Skin changes
Skin changes of chronic venous insuff
Low leg edema Inuration Brown discoloration Petechiae Dermatitis
Lipodermatosclerorsis
Atrophie blanche
Bowling pin seen in veinous
White base with severe red from hemosiderin
Tx of venous
Control of edema wiith compression
Dressings
Surgical interve3ntion
Decubitus ulcers
Over bony prom
From pressure, shearing, friction, moisture
Prolonged immobilization, sensory def, impaired consciousness, poor nutrition
Risk factors for decubitus
Impaired sensation
Reduced mobility
Incontinence
Staging of ulcers (pressure)
1 - intact skin with nonblanch redness
2- partial thickness loss of dermis
3 - full-thicknes loss of dermis
4 - full thickness loss with exposed bone, tendon, or muscle
Unstageable - full thickness loss in which base covered by slough or eschar
Imaging of ulcers
Plain radiograph - not really great
CT - define margin
MRI - most sensitive
Local infection of ulcers
Must use needle aspiration or biopsy to trest
Bacteremia
More in diabetic, malnoursiehd, immunosuppreessed
Osteomyelitis
Consider when it doesn’t heal
S aureus most common
Direct extension or through blood
managment of decuibuts
Wound care
ebridement
Tx of infection
Tx by sgtage
1 - protective dressings
2 - occlussive dressing
3 and 4- debridement, tx of infection, dressing
Neuropathic ulcer
Loss of sensation
Pressure and repetitive trauma…well demarcated borders and not inflamed
Plantar surface of the foot and painless
Red base with hyperkeratosis
May not be aware
Pathophys of neuro ulcer
Autonomic denervation of arterioles cuases vasodilation and chronic edema
Atrophy of intrinsic muslces of the foot `
Imaging neuropathic
May ID foreign body or osteomyelitis
Venous
Location Pain Skin Edges Base Cellulitis Tx
Above medial and lateral malleoli No, unless infected Stasis pigmentation Clean Wet, weeping, healthy, granulation Common Compression
Arterial Location Pain Skin Edges Base Cellulitis Tx
Shins, toes, sites of injury Yes Shiny, pale, decreased hair Smooth Dry, pale with eschar Often Revascularize
Neuropathic
Location Pain Skin Edges Base Cellulitis Tx
Plantar surface and pressure points No Callous, normal to changes of ischmeia Trophic and calloused Healthy to pale depending on PAD Common Remove pressure
