Venous ulcers Flashcards
Define venous ulcers
Large, shallow, sometimes painful ulcers usually found superior to medial malleoli
Caused by incompetent valves in lower limbs leading to venous stasis & ulceration
Aetiology of venous ulcers
2
Caused by incompetent valves in the lower limbs
Leads to venous stasis & increased venous pressure —> ulceration
Risk factors for venous ulcers
6
Obesity Immobility Recurrent DVT Varicose veins Previous injury/surgery to leg Age
Epidemiology of venous ulcers
prevalence, age
VERY COMMON
Increases w/ age
Presenting symptoms of venous ulcers
3
Large, shallow ulcer w/ irregular margin
Relatively painless
Situated above medial malleoli (often)
Presenting symptoms of venous ulcers - history
6
Varicose veins DVT Phlebitis Fracture, trauma or surgery FH Other symptoms of venous insufficiency -swelling, itching, aching
Signs of venous ulcers on physical examination
3
As above
Other signs:
Stasis eczema
Lipodermatosclerosis (inverted champagne bottle sign if SEVERE)
Haemosiderin deposition (dark colour)
Investigations for venous ulcers
4 types
ABPI
Measure SA of ulcer
Swabs for microbiology
Biopsy
Investigations for venous ulcers - ABPI
2
Exclude arterial ulcer
If ABPI <0.8 do NOT apply pressure bandage as could worsen ulcer
Investigations for venous ulcers - measure SA
To monitor progression
Investigations for venous ulcers - swabs for microbio
If signs of infection
Investigations for venous ulcers - biopsy
If possibility of Marjolin’s ulcer
Management of venous ulcers
4
Graduated compression (reduced venous stasis)
Debridement & cleaning
Antibiotics - if infected
Topical steroids - may help surrounding dermatitis
Complications of venous ulcers
2
Infection
Recurrence
Prognosis of venous ulcers
2
GOOD
Results better if patient is mobile w/ few comorbidities
