Skin Ulcers Flashcards
Leg ulcers - mainly due to venous or arterial?
Venous disease account for 70%
15% are mixed arterial and venous
2% are arterial
RF
DM Infection Malignancy Vasculitis Smoking
What should you ask about?
DM
VV
PAD
Is pt on steroids?
How do you investigate?
Skin and ulcer biopsy – to assess for vasculitis or malignant change in an established ulcer.
Can often be the first sign of a systemic disorder – so may require further screening.
Conservative Tx?
o Optimize nutrition.
o Consider referral to specialist community nurse or tissue viability clinic.
why don’t we use Abx?
routine use of Abx doesn’t improve healing unless sign of infection.
Types of dressings we can use?
charing cross?
Honey dressings?
-ve pressure wound therapy (VAC)?
Larval therapy/hydrogels?
why dont we use hydrogels in diabetics?
Charing-cross’ 4 layer compression bandaging (use only if ABPI >0.8).
o Honey dressings – for mild/moderate burns.
o Negative pressure wound therapy (VAC) for diabetic ulcers.
o Surgery/larval therapy/hydrogels are used to debride necrotic tissue.
o Avoid hydrogel in diabetic ulcers due to increased risk of wet gangrene.
where do venous ulcers tend to lie?
favourite place for venous ulcers?
above medial or lateral malleoli
over medial malleoli
where do arterial ulcers tend to lie?
under heel
over toe joints
anterior shin
if ulcer and surrounding tissue is cold?
if skin is warm and well perfused?
ischaemic ulcer
suggests local factors are more likely
if ulcer is punched out?
ischaemic
if ulcer is rolled/everted?
malignant
if ulcer is sloping/shelved?
healing
watery discharge?
TB
blood stained discharge?
malignancy
