Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management

Table 3

Assessment of leg ulcers: The difference between venous and arterial disease [29].

Assessment criteria	Venous disease	Arterial disease
Presenting history, physical and social risk factors	Previous history of DVT; Varicose veins; Reduced mobility; Traumatic injury to the lower leg; Obesity; Pregnancy; Nonhealing ulceration; Recurrent phlebitis; Previous vein surgery	Diabetes; Hypertension; Smoking; Previous history of vascular disease; Obesity; Inability to elevate limb
Position of ulceration	Gaiter area of the leg; Common site is medial aspect	Lateral malleolus and tibial area are common sites as well as toes and feet; Over pressure points
Pain	Throbbing, aching, and heavy feeling in legs; Improves with elevation and rest	Intermittent claudication; Can be worse at night and at rest; Improves with dependency
Ulcer characteristics	Shallow with flat margins; Often presents with slough at the base with granulation tissue; Moderate to heavy exudate	Punched out, occasionally deep; Irregular in shape; Unhealthy appearance of wound bed; Presence of necrotic tissue or fixed slough; Low exudate unless ulcers infected
Condition of the lower leg	Haemosiderin staining; Thickening and fibrosis; Dilated veins at the ankle; Crusty, dry, and hyperkeratotic skin; Eczematous, itchy skin; Pedal pulses present; Normal capillary refill (less than three seconds); Limb edema is common	Thin, shiny, and dry skin; Reduced or no hair on lower leg; Skin feels cooler to touch; Pallor on leg elevation; Absence or weak pedal pulses; Delayed capillary refill (greater than three seconds); Development of gangrene