Venous Ulcers

• What are the features of venous ulcers?

  Larger than arterial ulcers

  More superficial

  Irregular, gently sloping borders

  Gaiter area of leg (mid-calf to ankle)

  Less painful

  Bleed/ooze

  Other signs of chronic venous insufficiency (haemosiderin staining, venous eczema)
• What causes venous ulcers?

  Insufficient blood return from lower limbs
• What are the RFs for venous ulcers?

  Older age

  Obesity

  Reduced calf muscle pump action (immobility, sedentary, limited ROM of ankle, prolonged standing)

  Female

  Hx of DVT, leg fracture or varicose veins

  FHx of leg ulcers

  Pregnancy
• What are the Inx for venous ulcers?

  Exam

  ABPI (assess for PAD)

  Skin swabs (if suspect infection)

  Bloods (FBC, albumin, U&Es, HbA1c, CRP)

  Doppler USS
• What is the management of venous ulcers?

  Wound care

  Analgesia (prior to cleaning)

  Compression therapy

  • ABPI before
  • strongest compression they can tolerate

  Pentoxifylline (can be used to enhance wound healing)

  Prevent recurrence

  • encourage pts to mobilise
  • elevation
  • emollients & well-fitting footwear
  • compression
  • weight loss (if BMI > 30)
• What are the possible complications of venous ulcers?

  Infection

  Sepsis

  Osteomyelitis

  Recurrence