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