Ulcers Flashcards
What are risk factors for venous leg ulcers?
Varicose veins DVT Venous insufficiency Poor calf muscle function AV fistulae Obesity Leg fracture
What are causes of ulcers?
Neuropathy
Vascular: venous 75%, arterial 10%, mixed 15%
Trauma
Pyoderma gangrenous (w/Crohn's UC) Sickle cell Vasculitis SLE Infection drugs Malignancy
Where are venous ulcers normally seen? Arterial ulcers?
above MEdial Malleolus - Venous
above LAteral malleolus - arterial
What investigations in venous ulceration?
Ankle-brachial pressure index (ABPI) is important in non-healing ulcers to assess for poor arterial flow which could impair healing
Normal ABPI may be regarded as between 0.9 - 1.2.
Values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)
What management for venous ulceration?
Compression bandaging, usually four layer (only treatment shown to be of real benefit)
*do doppler’s first to rule out arterial disease ABPI > 0.8
Ulcers heal more quickly with occlusive dressings which absorb exudate and improve comfort.
Analgesia
Oral pentoxifylline, a peripheral vasodilator, improves healing rate
What advice for preventing venous ulcers?
Wear compression stockings Skin care Leg elevation Calf exercises Good nutrition
What are pressure ulcers? Where do they occur? In who?
Result from uninterrupted pressure on the skin, leading to ulcer and extensive painful subcutaneous destruction.
E.g. on the sacrum, heel, greater trochanter - bony prominences
Pressure ulcers develop in patients who are unable to move parts of their body due to illness, paralysis or advancing age
Shearing forces from sliding down bed, friction from being dragged across bedsheet and moisture from incontinence are implicating factors
What are risk factors for pressure ulcers??
Extremes of age Malnourishment Reduced mobility and sensation Vascular disease Chronic illness Incontinence Pain
What are stage 1 pressure ulcers?
Non-blanching erythema over intact skin
Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin
What are stage 2 pressure ulcers?
Partial thickness skin loss e.g. shallow crater
Involving epidermis or dermis or both
Ulcer is superficial and presents as an abrasion or blister
What are stage 3 pressure ulcers?
Full thickness skin loss, extending into fat
Necrosis or damage of subcutaneous tissue but not through underlying fascia
What are stage 4 pressure ulcers?
Destruction of muscle, bone or tendon with or without full thickness skin loss
What is the management of pressure ulcers?
Pressure relieving mattresses and cushions
Analgesia
Frequent repositioning - turning charts
Optimise nutrition - nutritional assessment
Treat systemic infection with abx - clinical assessment not swab
Use modern dressings to create an optimum environment to aid wound healing - moist wound environment - hydrocolloid and hydrogels
Debride dead or necrotic tissue
What are prevention for pressure ulcers?
Regular inspection
Minimise excess moisture
Proper positioning and regular turning - every 2h
Use pillow to separate the ankles and knees.
