Approach Expose limb Inspection Site - over tips of toes / pressure areas Shape - highly variable Edge - punched out / clean (no partial healing) Base - contains slough and may be infected, no healthy granulation tissue May be deep down to bone and underlying joint Skin: grey/blue colour Palpation Temperature using back of hands: note surrounding skin cold compared with proximal limb and contralateral foot Check peripheral pulses Check pulses of other leg Percussion Auscultation Causes of ischaemic ulcers Large vessel disease Atherosclerosis Thromboangiitis obliterans Small vessel disease Diabetes mellitus Polyarteritis nodosa Rheumatoid arthritis Analgesia available for patient Ischaemic ulcers are painful Consider analgesic ladder Management Non-surgical Risk factor modification - stop smoking, good DM control, BP control, optimized serum lipid levels Symptom modification: avoid B-blockers Low dose aspirin IV prostaglandins: inhibit platelet aggregation Lumbar sympathectomy reduces sympathetic-mediated vasoconstriction and improves perfusion by allowing unopposed vasodilation of skin vessels Surgical
Approach
Causes of ischaemic ulcers
Analgesia available for patient
Management
