Leg Ulcers

Dr Sarah Michaels looks at all you need to know about the various important types of leg ulcers.

 

Video Duration: 18 minutes

  • Venous Leg Ulcers
    Created by Alison Thornton
    General
    Epidemiology

    Definition of leg ulcer: loss of skin below the knee, taking more than 2 weeks to heal. A leg ulcer may be venous, arterial or both.

    Epidemiology: the prevalence increases with age and obesity. Venous ulcers are the most common, and the majority are managed in the community.

    Pathology

    Venous ulceration: venous hypertension develops due to inadequate calf pump action, and due to valvular incompetence.

    Top three causes

    Causes:

    1. Varicose veins

    2. Previous DVT

    3. Family history of venous disease

    Clinical Features
    Symptoms
    • Located usually around the lower leg around the medial/lateral malleoli
    • Mild pain - usually relieved on elevating the leg
    • Fever symptoms may be present if infection present
    Signs
    • Peripheral oedema
    • Larger and shallower than other ulcers
    • Varicose veins
    • Stasis dermatitis
    • Hyper pigmentation
    • Atrophie blanche
    • Pyrexia - check for infection
    Investigations
    Cultures

    Urine dip - Glucose (sign of diabetes)

    If infection suggested on inspection, take swabs

    Bloods

    FBC, ESR, U+E, creatinine, autoantibodies

    Imaging

    None

    Scopic/Biopsy

    If fails to heal after 12 weeks then do a biopsy

    Functional

    Assess the ulcer: size, shape, border, edge, base, surrounding skin

    Check peripheral pulses

    Check sensation

    ABPI: Ankle-brachial pressure index

    - 1 is normal

    - 0.5-0.8 suggest arterial disease, refer to vascular clinic

    - <0.5 suggest arterial ulcer and compression treatment is contra-indicated

    Doppler

    Treatment
    Conservative

    Lifestyle management - weight loss

    Pain relief if pain associated

    Bed rest

    Elevation of limb

    Medical

    Graduated compression - done in primary care normally

    Debridement and cleaning

    Dressing

    Antibiotics if infected

    Chronic venous ulcer: Pentoxifylline

    Topical steroids


    Surgical

    Venous surgery and skin grafting available, but rarely done