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Leg Ulcers
 

Leg Ulcers

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    Leg Ulcers Leg Ulcers Presentation Transcript

    • Adelaide & Meath National Children’s Hospital, Tallaght Sean Tierney, Consultant Vascular Surgeon Pathogenesis of Leg Ulcers
    • Barrier
    • Balanced forces
    • Pathogenesis - destruction
    • Pathogenesis – failure of repair Oxygen >>>Nutrients
    • Causes of Ulceration
      • Venous disease 81%*
        • 1 o
          • deep venous failure
          • superficial venous failure
          • combined
        • 2 o DVT
      • Arterial disease 10%
      • Mixed (arterial venous) 7%
      • Diabetic neuropathy 1%
      • Malignancy 1%
      • Rheumatoid 1%
      * O Brien et al. “ Prevalence and aetiology of leg ulcers in Ireland.” Ir J Med Sci 2000 17%
    • Trauma
    • Venous insufficiency normal Normal microvasculature
    • Venous insufficiency P P Normal Venous hypertension DVT & recanalisation Superficial reflux Defective deep valves
    • Venous insufficiency  Pressure
    • Venous insufficiency Normal High pressure
    • Venous ulcer
      • History of venous disease
        • DVT>>VVs
      • Recurrent
      • “ Painless”
      • Signs of venous hypertension
        • haemosiderin,
        • lipodermatosclerosis,
        • eczema
        • ± flares/spider veins
      • Note
      • Normal ABIs
      • Pain
      “ sloping”
    • Compression therapy * Diamond P. Management of leg ulcers in a rural community. J Wound Care 1994
    • Role of Surgery * Gohel et al. British Journal of Surgery 2005; 92: 291–297
      • open or recently healed ankle ulceration (>4 weeks)
      • ABI < 0·85
      • Either
        • superficial venous reflux
        • mixed superficial and deep venous reflux
      • Excluded
        • No reflux, deep reflux only, deep occlusion
    • Role of Surgery * Gohel et al. British Journal of Surgery 2005; 92: 291–297 Healing Recurrence
    • Dangers of compression  Pressure
    • Quantifying arterial perfusion
    • ABI technique
    • ABI technique P
    • ABI technique – calcified vessels P
    • Arterial ulcer
    • Arterial ulcer
      • History of intermittent claudication
      • Pain
      • Absent pulses
      • Reduced ABIs
      • Beware
      • Colour, temperature, capillary filling unreliable
      “ punched out”
    • Vasculitis
    • Vasculitic ulcer
      • History of inflammatory disease
        • RA
      • Unusual distribution
      • Painful
      • No venous disease
      • Normal arterial system
      • Note
      • may coexist with arterial or venous disease
    • Neuropathic Ulcer
    • Neuropathic ulcer
      • History of neuropathic disease
        • MS, DM
      • Pressure points
      • Loss of protective sensation
      • Painless
      • ± venous disease
      • ± arterial disease
    • Diabetes
    • “ Biopsy” Malignancy
    • Infective
    • History Differential diagnosis Examination Review differential diagnosis Investigation Treat Review differential diagnosis Evaluate response
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