Venous Ulcers

Question 1

Define Venous Ulcers

Answer 1

Ulceration of the lower limb due to venous insufficiency

Question 2

Aetiology of Venous Ulcers

Answer 2

Superficial or deep venous incompetence -> venous HTN + increased hydrostatic pressure -> tissue oedema -> impaired microcirculation (leakage of fibrinogen and fibrin build up impairs O2 deliver) -> tissue necrosis/ulceration

Deep veins: DVT
Superficial veins: varicose veins

Question 3

What proportion of leg ulcers are venous

Answer 3

80-85%

Question 4

Symptoms of Venous Ulcers

Answer 4

Heaviness
Leg ache
Ankle swelling
Skin changes 
Purity’s 
Ulceration (painless)

Question 5

Signs of Venous Ulcers on examination

Answer 5

Venous ulceration: 
Found in Gaiter area (above medial malleolus)
Painless
Heavy exudate (wet)
Shallow ulcer with sloped edges 

Surrounding skin changes: Lipodermatosclerosis | varicose eczema | haemosiderin deposition | atrophie Blanche

Question 6

Investigations for Venous Ulcers

Answer 6

ABI: <0.9 = mild-moderate PAD | < 0.4 = severe PAD

Infection:
Microbiology swab
Biopsy/cytology

Question 7

Management for Venous Ulcers

Answer 7

Multi-component compression bandaging (usually 4 layers)

Antibiotics for infection

Peripheral vasodilator - pentoxifylline PO

Leg elevation + increased mobility

Surgery for varicose veins

Question 8

Complications of Venous Ulcers

Answer 8

Chronic wound
Infection
Recurrence
Marjorlin’s ulcer -> pre-disposes to SqCC

Question 9

Prognosis for Venous Ulcers

Answer 9

Often chronic
Variable healing rate
Recurrence 25% at 1 year