Pathophysiology
- Arterial Ulcers
- Occur due to poor blood supply to the skin due to peripheral arterial disease
- Venous Ulcers
- Occurs due to pooling of blood and waste products in the skin secondary to venous deficiency (varicose veins, DVT, phlebitis etc)
- Mixed ulcers
- A combination of arterial and venous disease causing the ulcer
- Small wounds (e.g. a tiny cut or pressure sore) cannot heal due to poor blood supply
- It progressively gets larger and more difficult to heal
- Potentially has complications such as infections
Distinguishing Features
Arterial
- Absent pulses
- Pallor
- Tend to be smaller
- More regular boarder
- Grey colour due to poor blood supply
- Less likely to bleed
- More painful than venous ulcers
- Pain at night when legs elevated
- Pain worse on elevating the leg, improved by hanging
Venous
- Oedematous flushed skin
- Hyperpigmentation to skin
- Varicose eczema
- Tend to be larger
- Irregular boarder
- More likely to bleed
- Pain relieved by elevation and worse on hanging
Management
- Treating underlying cause (i.e. arterial or venous disease)
- Good wound care
- Debridement
- Cleaning
- Dressing
- Antibiotics where infected
- Tissue viability nurse and district nurse input
- Plastic surgery input in severe ulcers
- Skin grafts in severe and appropriate cases