Venous Ulcers.

Venous ulcers may result from trauma or chronic venous insufficiency. Chronic venous insufficiency (CVI) is when the venous valves do not close completely. This results in a backflow from the major venous system into the smaller superficial vein. The valves can be damaged as a result of deep vein thrombosis (DVT). The backflow of blood, over time, will exude fluid and protein into the surrounding tissue which will breakdown. In addition to this oedema will form which can result in copious drainage from the ulcer site. Patients with a venous ulcer may have a previous medical history of: DVT, thrombophlebitis and varicose veins.

Arterial Ulcers

Arterial ulcers may develop as a result of arterial insufficiency which can be caused by many factors such as: chronic vasoconstriction, arteriosclerosis , vessel compression, inflammatory disease and trauma. The affected limb can become ischaemic and very painful. Claudication of the calves may also be present following exercise due to ischaemia in the calf muscles. If pain is present at rest this indicates severe arterial insufficiency. Patients with an arterial ulcer may have a past medical history of: angina, hypertension, diabetes, peripheral vascular disease and an ABPI of less than 0.5.

  DIFFERENTIATING ULCER TYPES
 

Arterial ulcers

  

Venous ulcer

  

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Dr Allan   Freedline ,Dr Tamara D.Fishman

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Wound site

 

 

On lower limb or foot including ankle and toes.There may be multiple lesions.

 

Gaiter region around medial malleolus from instep to above the ankle.

  

Appearance

 

 

 

The ulcer may be deep with the absence of granulation tissue.Necrotic tissue with slough is present and it may be possible to see underlying tendon , muscle or bone.

  

The ulcer is usually shallow and flat.It may be pale in appearance with evidence of granulation tissue.

 

  

Foot pulses

 

Absent or very dimished.

 

  

Are usually present but may be difficult to palpate if oedema is present.

  

Pain

 

 

 

Very painful (unless neuropathy is present).The pain may be intractible with burning or stabbing sensations.Pain may increase with exercise.

  

Can be painful if oedematous. Exposed superficial nerves may result in stinging or burning sensations

  
         

Skin changes

 

 

 

Skin may be pallid and cold to touch with a shiny surface.Black eschar may be present  as well as hair loss.The foot may blanch on elevation and there may be little or no oedema.

  

May be ruddy and macerated.There  may be copious oedema drainage atrophy and ankle flare.The skin is warm to touch and eczema may be present.