Venous ulcers

Question 1

What are venous ulcers?

Answer 1

large, shallow ulcers usually found superior to the medial malleoli.

Question 2

Describe the aetiology of venous ulcers

Answer 2

Caused by incompetent valves in the lower limbs which leads to venous stasis + increased venous pressure
This results in ulceration

Question 3

List 6 risk factors for venous ulcers

Answer 3

Obesity  
Immobility 
Recurrent DVT  
Varicose veins  
Previous injury/surgery to the leg  
Age

Question 4

Summarise the epideimiology of venous ulcers

Answer 4

VERY COMMON

Increases with age

Question 5

List 6 features that may be in the history of a patient with venous ulcers

Answer 5

Varicose veins  
DVT  
Phlebitis  
Fracture, trauma or surgery  
FH
Other symptoms of venous insufficiency: Swelling, Itching, Aching

Question 6

Describe the appearance of venous ulcers

Answer 6

Large, shallow, relatively painless ulcer with an irregular margin situated above the medial malleoli (usually)

Question 7

List 3 signs that may present with venous ulcers

Answer 7

Stasis eczema
Lipodermatosclerosis (inverted champagne bottle sign if SEVERE)
Haemosiderin deposition (dark colour)

Question 8

List 4 investigations for venous ulcers

Answer 8

ABPI: Exclude arterial ulcer. If < 0.8 DONT apply a pressure bandage as this could worsen the ulcer
Measure SA of ulcer: for monitoring of progression
Swabs for microbiology if signs of infection
Biopsy if possibility of Marjolin’s ulcer

Question 9

What is the management plan for venous ulcers?

Answer 9

Graduated compression (reduced venous stasis)- must exclude diabetes, neuropathy + PVD before this is attempted
Debridement + cleaning
Abx if infected
Topical steroids: to help with surrounding dermatitis

Question 10

What is the prognosis for venous ulcers?

Answer 10

GOOD

Results are better if pts are mobile with few comorbidities

Question 11

Give 2 complications of venous ulcers

Answer 11

Recurrence

Infection