Leg ulcers
| Headline | |
|---|---|
| Etiology | Chronic wound = wound without response to conventional treatments/continues enlarging over 6/52 without extrinsic factors |
| Epidemiology | |
| Clinical presentation | Pain (including claudication and rest pain); mobility e.g. fixed joints ➥ Arterial: pale, tense skin, loss of hair, punched-out edges ➥ Venous: haemosiderin deposition, atrophie blanche, peripheral oedema, exudative; gaiter distribution ➥ Diabetic: punched out, callus, peripheral neuropathy; distribution: pressure areas ➥ Rheumatoid: inflammatory violaceous margin, skin atrophy, other signs of RA ➥ Signs of infection: dark red granulation tissue, bleeds on contact. Common organisms: Staphylococcus aureus, Enterococci, group B beta strep, Pseudomonas aureginosa Ddx: |
| Pathogenesis | |
| Diagnostic investigations | |
| Management | ➥ Rule out SCC (Marjolin’s) ➥ Debride callus → check for infection, relieve pressure on wound ➥ Barrier cream ➥ Abx ONLY if infected (not colonised) ➥ D/w nurses, DNs, TVNs re dressing choice ➥ Check for other end-organ damage ➥ Would expect venous ulcers to heal by 1 year ➥ Refer diabetic/rheumatoid ulcers |
| Prevention |
If you're thinking "bilateral cellulitis", consider an alternative dx.
- superinfected Eczema?
- contact dermatitis to dressings?
History taking aspects
➥ Wound history: precipitating event e.g. trauma, insect bite, cellulitis; duration; whether the wound is healing/deteriorating + rate of change
➥ Previous ulceration
➥ PMH e.g. diabetes, rheumatoid arthritis, systemic sclerosis, hypertension; varicose veins, DVT, previous trauma/surgery
➥ Family history (varicose veins, DVT)
➥ Concomitant medication