Venous Ulcers

Question 1

What is the definition venous ulcers?

Answer 1

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.

Question 2

What aetiology of venous ulcers?

Answer 2

They are caused by incompetent valves in the lower limbs

Valve incompetence leads to venous stasis and increased venous pressure

This results in ulceration

Question 3

What are the risk factors of venous ulcers?

Answer 3

Obesity

Immobility

Recurrent DVT

Varicose veins

Previous injury/surgery to the leg

Age

Question 4

What is the epidemiology of venous ulcers?

Answer 4

VERY COMMON

Increases with age

Question 5

What are the presenting symptoms of venous ulcers?

Answer 5

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
• Family history
• Other symptoms of venous insufficiency:
• > Swelling
• > Itching
• > Aching

Question 6

What are the signs of venous ulcer upon physical examination?

Answer 6

Described above

Other signs of venous ulcers:

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

Question 7

What is the management plan for venous ulcers?

Answer 7

Graduated compression (reduced venous stasis)  
- NOTE: must exclude diabetes, neuropathy and PVD before this is attempted  

Debridement and cleaning

Antibiotics - if infected

Topical steroids - may help with surrounding dermatitis

Question 8

What are the possible complications of venous ulcers?

Answer 8

Recurrence

Infection

Question 9

What is the prognosis for patients for venous ulcers?

Answer 9

GOOD

Results are better if patients are mobile with few comorbidities