Leg Ulcers

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
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