Skin Ulcers Flashcards
1
Q
Types of ulcers?
A
- Venous ulcers (venous blood stasis)
- Arterial ulcers (from PVD)
- mixed venous and arterial ulcers
- pressure sores and diabetic ulcers
- Other rarer:
- autoimmune vasculitis; with SLE, RA
- tropical disease
- TB
- skin cancers
- insect / spider bites
Most ulcers are multifactorial with obesity and sedentary lifestyle.
Regular wound dressing, removal of dead tissue, moist dressing, often colonised so no swabs. compression bandages, consider SSC.
2
Q
What are the causes of leg ulcers vs foot ulcers?
A
Leg ulcers:
- 65% venous
- 15% arterial
- 20% other causes
Foot ulcers:
- 5% venous
- 70% arterial
- 25% other causes
3
Q
What factors are important in an ulcer history?
A
PVD factors:
- smoker or exsmoker
- known CVD (CVA, MI, angina)
- Hx claudication
PHM
- PVD
- diabetes
- rheumatoid arthritis, SLE or IBD
DHx
- beta blockers (can reduce peripheral blood flow)
- steroids / NSAID (can reduce skin healing)
4
Q
Things to think about when examining ulcers?
A
- check peripheral pulses! weak / absent suggest arterial disease
LOCATION
- inside ankle and calf; likely venous ulcer
- areas of pressure: likely diabetic ulcer
- lateral foot and lower leg: likely arterial ulcer
- sun exposed areas think skin cancers
APPEARANCE
- “punched out” means clean straight edges and base, more likely arterial
- “undermined” lesions mean wide base relative to the opening; more likely presssure or diabetic
- lesion with raised edges suggest skin cancer (BCC or SCC)
- dry base of ulcer; suggests arterial
- moist base ulcer; suggests venou
5
Q
Grading of pressure sores?
A
I - non-blanching erythema
II - partial thickness ulceration
III - full thickness ulceration
IV - deep full thickness with extensive skin and tissue loos (can see subdermal layers)
6
Q
Management
A
Arterial ulcers:
- treat underlying insufficiency (referral to vascular surgeon)
VENOUS ulcers:
- change dressings
- avoid antiseptics (damage cells)
- Abx only if cellulitis
- Compression
- Elevation (60mins BD)
- med review (steroids, NSAIDs, beta blockers, smoking)
- increase exercise
- may need surgery for varicose veins
PRESSURE SORES:
- relieve pressure
- change dressing
- vitamin C 500mg BD
- Abx not indicated unless celulitis
- negative pressure therapy may be useful
- optimise nutritional status
