EXAMINATION OF AN ULCER Adequately expose the ulcer.

Describe: Intro: Site Size Tenderness Define: Shape Depth Edges: Sloping Punched out Undermined Rolled Everted Base: Healthy Sloughy Avascular Purulent Necrotic Underlying structures visible?

Surrounding Tissues: Erythema/cellulitis. Arterial & Venous & Neurological assessment. Offer as appropriate: Vascular examination Venous examination Neurological examination.

Make a Diagnosis: Is the ulcer painless? NO Are foot pulses present? YES ?Venous NO Probably ischaemic

YES Neurological Cause

NB: Beware of multiple pathologies, esp. in diabetic patients. (Peripheral Vascular Disease + Neurological Ulcers). Glossary-Describing the Edge: Flat Sloping Edge: healing ulcer, usually shallow, typical of a venous ulcer. Punched-out/Vertical Edge: rapid death and sloughing of the full thickness skin without attempt at repair. Typical of neuropathic/vasculitic ulcers. Historically Syphilitic Ulcers, -now rare. Undermined Edge: occur when infection supervenes in subcutaneous tissue, e.g. pressure sores. Historically caused by tuberculous ulcers. Rolled Edge: develops when there is slow growth of tissue at the edge of the ulcer. Almost pathognomonic of BCC. Everted/Heaped Edge: develops when tissue at the edge of the ulcer is growing quickly & spilling over normal skin. Usually SCC.