SKIN ULCERATION Leg ulcers and pressure sores The majority of leg ulcers are venous (gravitational) ulcers, commonly occurring in women and often associated with previous thrombosis of the deep venous system. Ulceration frequently involves the medial malleolar region, and there is often purplishbrown discoloration and white fibrosis with purpura of the surrounding skin (atrophie blanche). Varicose eczema and varicose veins are commonly associated with venous ulcers. Important aspects of treatment include elevation

and adequate compression or elastic support, such as the 4-layer bandage system, once Doppler (ultrasound) studies have been performed to make sure the arterial supply is not significantly impaired. A number of dressings have been developed, the aim of which is to keep the ulcer moist and free from infection. In the absence of signs of infection, such as cellulitis, a wound swab from the ulcerated surface may be misleading.