Venous ulcers

Question 1

Define

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.

Question 2

Causes

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

Risk factors

Answer 3

Obesity

Immobility

Recurrent DVT

Varicose veins

Previous injury/surgery to the leg

Age

Question 4

Epidemiology

Answer 4

VERY COMMON

Increases with age

Question 5

Symptoms

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

Signs

Answer 6

-Described above
-Other signs of venous ulcers:
Stasis eczema
Lipodermatosclerosis (inverted champagne bottle sign if SEVERE)
Haemosiderin deposition (dark colour)

Question 7

Investigations

Answer 7

ABPI:

• Exclude arterial ulcer
• 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

Question 8

Management

Answer 8

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 9

Complications

Answer 9

Recurrence

Infection

Question 10

Prognosis

Answer 10

GOOD

Results are better if patients are mobile with few comorbidities