Vascular: ulcers Flashcards
Causes of venous leg ulcers?
Venous hypertension, chronic venous insufficiency
Features of venous ulceration?
oedema, brown pigmentation, lipodermatosclerosis, eczema
Where do venous uclers commonly form?
Above the ankle
Management of venous ulcers?
cleaning, debridement and dressing, 4 layer compression banding
Elevate the legs
Use emollients to protect skin barrier
if non healing - tissue viability.
Where do arterial ulcers commonly form?
Toes and heels
Cause of arterial ulcers?
insufficient blood supply to skin due to peripheral arterial disease
Features of arterial ulcers?
Cold with no palpable pulses, low ABPI index, possibly pitting oedema due to co-morbities
Cut offs for arterial disease in APBI?
<0.5 severe arterial disease
0.5-0.8- arterial disease or mixed arterial venous disease
Management of arterial ulcers?
Urgent vascular review
Conservative- smoking cessation, lose weight, exercise, CVS modification- anti-platelets, statins
May need bypass or graft
Common sites for neuropathic ulcers?
Plantar surface of metatarsal head and plantar surface of hallux
Cause of neuropathic ulcer?
Pressure- lack of sensation (i.e loss of protective sensation) so injuries go unnoticed, immunocompromised and increased blood glucose leads to impaired wound healing
Management of diabetic foot ulcer
referral to diabetic foot ulcer clinic
optimise diabetic control
improve diet and exercise if approriate
regular chiropody to ensure good foot hygiene and
appropriate footwear
may need surgical debridement
skin swabs and Abx (flucloxacilin) if infection suspected
amputation in severe necrotic/infected cases
Location of diabetic foot ulcers?
Heel of foot, metatarsal heads
Investigations for diabetic foot ulcer?
ABPI, doppler to assess blood flow, blood glucose including HbA1c, skin swabs. XR if concerned of osteomyelitis.
Management of venous ulcers
compression bandaging, usually four layer (only treatment shown to be of real benefit)
oral pentoxifylline, a peripheral vasodilator, improves healing rate
