Vascular ulcers

Question 1

Define ulcer

Answer 1

Interruption in the continuity of an epithelial surface

Question 2

What are the causes of ulcers?

Answer 2

Venous - most common
Arterial
Neuropathic - Alcoholics, DM
Trauma - Pressure
Systemic disease e.g. pyoderma gangrenosum 
Neoplasia - SCC

Question 3

What are the properties of a venous ulcer?

Answer 3

Shallow sloping sides
Painless
Usually medial gaiter region

Question 4

What are the risk factors for a venous ulcer?

Answer 4

Venous insufficiency
Varicosities
DVT
Obesity

Question 5

What are the properties of an arterial ulcer?

Answer 5

Punched out, deep lesion
Painful
Appears at pressure points eg heads of metatarsals, heal

Question 6

What are the properties of a neuropathic ulcer?

Answer 6

Painless with loss of sensation in surrounding skin
Warm foot
Good pulses
Tend to be on the base of the foot

Question 7

What are some of the complications of an ulcer?

Answer 7

Osteomyelitis

Development of SCC in the ulcer

Question 8

What investigations can be done in a patient with an ulcer?

Answer 8

ABPI - Ankle brachial pulse index (Less than 0.5 suggests arterial ulcers)
Duplex ultrasonography
Biopsy if concerned about SCC

Question 9

What is the management of venous ulcers?

Answer 9

Refer to community ulcer team
Focus on prevention - pressure stockings, venous surgery
Optomise RFs eg smoking, nutrition
Analgesia
Bed rest/leg elevation
4 layer graded compression bandage if ABPI >0.8

Question 10

Define mixed ulcer

Answer 10

An ulcer which has developed in a patient with venous and arterial pathology
Use ABPI to determine management