Venous Ulcers Flashcards
def
ulceration of lower limb by venous insufficiency
80% of leg ulcers
what % of ulcers in the legs are venous and arterial
venous 80%
arterial 20%
aetiology
venous HTN results in increased hydrostatic pressure, tissue oedema, impaired microcirculation which leads to tissue necrosis + ulceration
epi
increases with age
female>male
history
chronic venous insufficiency can result in
1 leg aching
2 ankle swelling
3 itching
examination
1 ‘gaiter area’ above medial malleolus is classic position of venous ulcer
2 ulceration is shallow, sloping edges, lipodermatosclerosis
3 examine for varicose veins with patient standing
what is lipodermatosclerosis
skin changes in the leg with venous insufficiency
- pigmentation
- inflammation
why should ankle-brachial pressure index be determined
to look for peripheral arterial disease
what are the DDx for venous ulcers
1 arterial ulcers
2 diabetic ulcers
investigations
1 ankle-brachial pressure index -for peripheral arterial disease -<0.5 should be managed for arterial insufficiency in the first instance 2 microbiology swab -with signs of infection 3 biopsy -exclude malignancy
management
1 multi-component compression bandaging
-correct venous HTN with Charing Cross four layer bandage
-leg elevation
-compression stockings to prevent recurrence
-antibiotics for infection
2 surgery
-treat varicose veins
what is the charing cross four layer bandage
bandage used to correct venous HTN in venous ulceration 1 wool 2 crepe 3 elastic 4 cohesive bandages
complications
1 chronic wounds
2 infection
3
recurrence
what is marjolins ulcer
complication of chronic venous ulcers
malignancy in long-standing ulcer
prognosis
high recurrrence rates (25% at one year)
