Leg Ulcers

Major causes of leg Ulcers

a. Arterial ischemic ulcers

b. Venous ulcers (most common)
c. Neuropathic ulcers (diabetic foot)
d. Sickle cell disease
e. Malignant ulcers

Arterial Ulcers

a. History of peripheral arterial disease, intermittent claudication (cramping of leg) and rest
pain
b. Classic site- pressure points- usually over toes, foot, ankle (lateral malleolus)
a. Edge is punched out (very deep)
b. Wound bed- deep wound, varying slough (inflammatory phase of wound healing)
c. Low exudate, edema uncommon
d. Extremely painful -pain lessens with dependency -hanging off the bed
a. Increased with leg elevation
e. Skin is pale, shiny, taut (tight) , little or no hair
f. Cold skin
g. Distal pulse absent
h. Capillary refill delayed
i. Perform and Doppler/ABI as part of examination
c. Treatment
a. Rest, no elevation or compression
b. Moist wound dressing and topical antibiotics
c. Debridement of necrotic tissue
d. Revascularization surgery
a. Balloon angioplasty
b. Stent
c. Amputation

Venous Ulcers

a. History of varicose veins, venous incompetence

b. Classic site- medial gaiter region of leg (just above medial malleolus)

mediallong saphenous veinproblem at sapheno-femoral junction

Lateralshort saphenous veinproblem at sapheno-popilteal junction

a. Edge is sloping and irregular

b. Wound bed is covered with slough at base and healthy granulation tissue that is
superficial
 c. Exudate level is high
d. Edema is common
e. Pain is moderate or absent
f. Look for obvious varicose veins
g. Hyperpigmentation -brown due to hemosiderosis (overload of iron)
h. Venous eczema

Treatment.

a. Compression in main stain

b. Best rest with foot of bed elevated which abolishes high venous pressure
c. Antibiotics given only if surrounding with cellulitis

Management of DM foot

a. Resuscitation – control fluid and electrolyte status

b. Control glucose
c. Control local sepsis- dressing, amputation and debridement
d. Control system sepsis- IV antibiotics
e. Rehabilitate/ educate (wound care , foot care)

Diabetic Foot

a. Neuropathy + vasculopathy (hunter/adductor canal) + immunopathy

b. Neuropathy
a.