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Medicine Notes > General and Vascular Surgery Notes
This is an extract of our Ulcers document, which we sell as part of our General and Vascular Surgery Notes collection written by the top tier of University Of Leicester students.
The following is a more accessble plain text extract of the PDF sample above, taken from our General and Vascular Surgery Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:
Ulcers "A breach in an epithelial surface" Can be classified
- Vascular o 85% venous o 15% arterial
- Neoplastic o BCC, SCC (chronic ulcers can also become neoplastic)
- Neuropathic o Diabetes
- Traumatic o Burns, cold, polycythemia, pressure sores
Features to look for on examination Site
- Legs and feet = vascular, neck/groin/axilla = TB anywhere =
malignant Surface
- Usually depressed - look for vascular granulations Size
- Is it large compared to history? Fast growing = pyoderma gangrenosum Shape
- Circular, straight edges, irregular Edges
- Eroded = spreading
- Shelved = healing
- Punched out = Syphillitic
- Rolled or everted = malignant Base
- Fixed to structures underneath, mobile, penetrating Discharge
- Purulent = infected
- Watery = TB, transudate
- Bleeding = malignancy/granulation Pain
- Suggests ischaemia, infection and growth Progress
- Short history = pyogenic
- Long history = vascular Lymph nodes
- Near ulcer = secondary infection or malignancy
Arterial ulcers (ischaemic ulcers) Pathogenesis Chronic arterial insufficiency produces ulceration because of skin ischaemia at areas of pressure Site (Ulcers are distal)
- Lateral malleolus
- Lateral foot
- Outer edges and between toes (especially little and great toes - pressure)
- Also at the heel Clinical features
- Pain, especially rest pain and night pain
- 'Punched out' appearance
- Deep - can extend to tendons Associated features
- Intermittent claudication
- Absent pulses
- Shiny, hairless skin
- "Blue toe" - micro-emboli
- Smoker/ex smoker Investigations
- Arterial circulation assessed using Doppler
- ABPI
- Angiography - used for severe disease (e.g APBI <
0.8)
- Xray to rule out osteomyelitis
Differential diagnosis
- Neuropathic ulcer
- Infected wound
- Gangrene
Management (Same as critical limb ischaemia)
- Lifestyle modification o Stop smoking, lose weight, exercise (increase collateral flow)
- Medical o Aspirin, glycaemic control, statin, antibiotics for infection
- Interventional/surgical o Angioplasty to improve perfusion Debridement once reo By-pass grafting vascularised o Amputation
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