Venous and Arterial ulcers

September 21, 2012 | By | Reply More

Venous and Arterial ulcers

Venous ulcers
Part of postphlebitic limb syndrome where there may be a history of past DVT. The ulcer is associated with oedema, lipodermatosclerosis (woody thickening of soft tissues around the calf), and venous congestion with secondary calf perforators and varicose veins. The ulcer is usually over the medial malleolus but can be large, involving the whole of the gaiter region.
  • If pulses are absent in the foot, there may be an arterial element, which can be excluded by measurement of the ankle to brachial pressure index (ABPI).
  • If any doubt persists, a vascular referral for arterial reconstruction should be considered but four-layer bandaging must be avoided when there is arterial insufficiency.
Arterial ulcers
These are often multiple and occur distally over and between the toes or at pressure points such as heels or malleoli. They may occur elsewhere on the leg, usually when there is an associated diabetic or venous element. There is usually a history of arterial disease, particularly peripheral vascular disease with claudication.
  • Unlike venous ulcers, where bacterial colonization is common, the presence of organisms suggests infection, particularly when there is moisture around the ulcers: wet gangrene (caused by staphylococci and streptococci, not clostridia; see later) may ensue with cellulitis.
  • If the leg is kept dry, infection is minimized and a line of demarcation may aid in decision-making for the level of amputation.
  • Arterial reconstruction should be considered before this stage.

Category: Pathology

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