Venous Ulcers Flashcards
Define venous ulcers
Venous leg ulcers or stasis ulcers are chronic wounds that occur primarily in the lower limbs due to impaired venous return resulting in increased venous pressure and subsequent skin breakdown
What is the relevant aetiology of venous ulcers?
Chronic venous insufficiency.
Valves in the leg veins malfunction - causes venous hypertension.
When prolonged capillary pressure increases causing fluid and blood cells to leak into the interstitial space.
Causes local hypoxia, inflammation and skin/subcutaneous tissue damage resulting in ulceration.
What are some risk factors for venous ulcers?
DVT
Obesity
Immobility
Advanced age
History or leg injury or previous venous ulcers
Where do venous ulcers tend to appear?
The gaiter area of the leg - from ankle to mid-calf.
Above the middle malleolus.
What do venous ulcers look like?
Irregular, shallow wounds with a granulating base and are often accompanied with substantial exudate.
Surrounding skin can show oedema, pigmentation, lipodermatosclerosis (hardeing and discolouration of the skin) and atrophe blanche (small, white scars surrounded by dilated capillaries)
Are venous ulcers painful?
Yes but less than arterial ulcers
What investigations should be done for venous ulcers?
ABPI - for poor arterial flow which may impair healing
Doppler ultrasound - for venous competence and arterial disease, particularly if considering for compression therapy
If not responding to treat or malignancy suspected a biopsy may be performed.
What is the main treatment for a venous ulcer?
Compression therapy - improve venous return and reduce oedema
Wound care - regular cleaning and dressing of the ulcer.
Topical agents - prevent bacterial growth and promote healing
Debridement in severe cases
Systemic - analgesics, antibiotics (if needed)
What treatment may be needed for a non healing or recurrent venous ulcer?
Surgical - endovenous ablation
Sclerotherapy - treat varicos veins, helps narrow veins
Venous valve repair
What are some key differentials for venous ulcers?
Arterial ulcers - typically found on the lateral malleolus or toes, exhibit a punched out appearance, often painful with poor granulation tissue
Neuropathic ulcers - commonly occur in patients with diabetes, generally located on areas of high pressure such as plantar aspect of the foot, and ar often painless with a calloused edge.
What lifestyle advise can help heal/prevent venous uclers?
Maintain cleanliness of the ulcer
Promote mobility
Suggest weight reduction
Recommend leg elevation at rest
What is pentoxifylline?
Why is it relevant to venous ulcers?
Improves the flow of blood through blood vessels - PDE5i
By improving arterial blood flow can help improve healing of the ulcer
Does not affect the process of ulcer formation.
What are some complications of venous ulcers?
Decreased mobility due to pain
Risk of infection which can progress to sepsis
Possibility of osteomyelitis
Decreased quality of life due to persistent pain and disability.
