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Leg ulcers

  

Management of ulcers on legs


Venous ulcers

Usually large and painless affecting lower part of leg and associated with venous incompetence

Compromise 80% of all leg ulcers

Other types of ulcer

Arterial ulcer

Painful and deep. Poor blood supply

Neuropathic ulcer

Painless and deep. Often over areas of trauma e.g. heels

Malignant ulcer

Rolled edges. Consider referral for biopsy in chronic non healing ulcers

Rheumatoid ulcer

Sharp edged and deep. Slow hearing. Often calf and dorsum of foot. Consider referral to rheumatology

Investigations

  • Consider blood tests FBC CRP HBA1c Albumin Autoantibodies Clotting Haemoglobinopathy screening
  • Swabs if signs of infection such as cellulitis
  • Measure surface area for monitoring
  • Ankle Brachial Pressure Index (ABPI) if peripheral arterial disease suspected (before graduated compression bandaging used)
  • Cuff applied to lower calf. Doppler detects systolic pressure in dorsalis pedis. Expressed as a ratio of upper limb systolic pressure. Ratio <= 0.8 suggests significant peripheral arterial disease
  • ABPI only can be requested via referral sent to the vascular Lab at UHCW or via radiology request form.
  • For patients suspected to have Peripheral Arterial Disease referral should be through C&B to the claudication service for holistic assessment as well as ABPI recording and first line treatment will be offered within a supervised exercise programme.

Management

  • Conservative management in primary care
  • Refer to Tissue Viability Wound Clinic for complex cases or failure of conservative management
  • Refer to Diabetic Foot Clinic Diabetic Foot Clinic if diabetic
  • Refer Rheumatology Rheumatology if rheumatoid ulcer suspected (DMARD therapy)
  • Refer Dermatology if malignancy suspected
  • Refer Claudication Clinic if if symptoms of Peripheral Arterial Disease
  • Refer Vascular surgery for intervention for varicose veins (see Low Priority Procedures: Varicose Vein Surgery)

 

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