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Venous Ulcer

Pathophysiology: Any cause of venous insufficiency

  1. Valvular disease
    • Varicose veins
    • Deep vein reflux
    • Communicating vein reflux
  2. Outflow tract obstruction
    • Post DVT
  3. Muscle pump failure
    • Primary - stroke, NM disease
    • Secondary - stiff ankle

 

Approach

  • Expose from groin to toes
  • Preserve dignity
  1. Inspect
    • Common in gaiter area
    • Size varies
    • Edge sloping, pale purple/brown in colour
    • Surround pigemtnation (lipodermatosclerosis)
    • Oedema, spider veins, telangectasia

  2. Palpate
    • Temperature - may be warmer than rest of leg

Completion

  • Examine limb for varicose veins
  • Measure ABPI (should be >0.8 before compression bandaging can be used)

Management of venous ulcers

  1. Non-surgical
    • 4 layer compression bandaging: (1) non-adherent dressing over ulcer + wool bandage (2) crepe bandage (3) blue-line bandage (4) adhesive bandage to prevent other layers from slipping
    • Elevation of leg
    • Once healed, compression stockings
  2. Surgical
    • Biopsy - may be Marjolin's ulcer
    • Split skin graft considered with excision of dead skin and graft attached to healthy granulation tissue
    • Surgery to varicose veins, if cause
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