ABSTRACT
VENOUS ULCERS Account for 70-80% of leg ulcers. ➤ Occur as a result of chronic venous insuffi ciency. ➤ Usually present on the medial surface of the lower leg. ➤ Surrounding skin is oft en pigmented. ➤ Bacteria oft en colonise ulcers – antibiotic treatment should only be employed if ➤ evidence of active infection. External pressure assists healing by improving venous return and reducing ➤ swelling. Provided there is no arterial compromise, four-layer compression bandages ➤ should be applied. Once healed, patients should be encouraged to wear compression stockings ➤ (assistance may be required for frail community-dwelling older people). Venous ulcers can coexist with arterial ulcers (mixed). ➤
ARTERIAL ULCERS 10% of leg ulcers are due to arterial insuffi ciency. ➤ Th e foot and lateral aspect of the lower leg are most commonly aff ected. ➤ Th e leg appears pale, dusky and cold with reduced/impalpable pulses. ➤ Intermittent claudication is a common presenting feature, although it may not be ➤ apparent in some older patients as comorbidity may restrict exercise tolerance. Rest pain may be a feature. ➤ Complications include cellulitis and osteomyelitis. ➤ Predisposing factors are smoking, hypertension, hypercholesterolaemia and ➤ diabetes mellitus. Risk factor modifi cation plays an important role in prevention/treatment. ➤ Ankle:brachial pressure indices <0.7 indicate an arterial component. ➤ Suitable patients should be referred to a vascular surgeon. ➤
DIABETIC ULCERS Approximately 5% of ulcers are related to diabetes mellitus. ➤
Oft en occur on the foot. ➤ fi ndings. ➤ deep-seated infection. Poor control of glycaemia/blood pressure/lipids, continued smoking, inadequate ➤ foot care, sensory neuropathy and badly fi tting shoes are contributing factors. Chiropody appointments every 3 months are advised. ➤
