Venous Ulcers

Question 1

Define Venous ulcers and summarise its aetiology and epidemiology.

Answer 1

Definition: Large, shallow, sometimes painful ulcers usually found superior to the medial malleoli. They are caused by incompetent valves in the lower limbs leading to venous stasis and ulceration.

Aetiology:
- Caused by incompetent valves in the lower limbs
- Valve incompetence leads to venous stasis and increased venous pressure
- This results in ulceration
- Risk Factors: 
   • Obesity
   • Immobility
   • Recurrent DVT
   • Varicose veins
   • Previous injury/ surgery to the leg
   • Age

Epidemiology:

• Very common
• Increases with age

Question 2

Describe the history/presenting symptoms of Venous ulcers

Answer 2

• Large, shallow, relatively painless ulcer with an irregular margin situated above the medial malleoli (most of the time)
• Features of the history:
  • Varicose veins
  • DVT
  • Phlebitis
  • Fracture, trauma or surgery
  • Other symptoms of venous insufficiency includes swelling, itching, aching

Question 3

What are the signs of venous ulcers upon physical examination?

Answer 3

• Large, shallow, relatively painless ulcer with an irregular margin situated above the medial malleoli (most of the time)
• Other signs of venous ulcers:
  • Stasis eczema
  • Lipodermatosclerosis (inverted champagne sign if SEVERE)
  • Haemosiderin deposition (dark colour)

Question 4

What investigations are used to identify venous ulcers?

Answer 4

• ABPI:
  • Exclude arterial ulcers
  • If ABPI < 0.8- do NOT apply a pressure bandage as this could worsen the ulcer
• Measure surface area of ulcer- allows monitoring of progression
• Swabs for microbiology- if signs of infection
• Biopsy- if possibility of Marjolin’s ulcer