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Skin ulcers

full-thickness defect in epidermis
Types
1. Arterial
  1. symptoms/signs
    1. ulcer
      1. well defined edges
        'punched out'
      2. V. PAINFUL
      3. deeper than venous
      4. location
        lateral surface of ankle & distal digits
        bony prominences
    2. Peripheral artery disease (PAD)
      1. absent pulses
      2. thin, shiny skin
      3. absence of hair, poor nail growth
      4. cold, blue skin
      5. CLAUDICATION
      6. rest pain in soles of feet when elevated
  2. investigations
    1. Ankle Branchial Pressure Index (ABPI)
      1. PAD = <0.9
    2. X-ray
      1. osteomyelitis
  3. management
    1. antibiotics
    2. vascular surgery referral
      1. vascular bypass
      2. angiography
    3. lifestyle
      1. Stop smoking
      2. Glycaemic control
  4. reduced blood flow due to narrowing of arteries -> ischaemia
2. Venous
  1. symptoms/signs
    1. ulcer
      1. irregular, undefined shape
      2. superficial
      3. location
        medial malleolus
    2. lipodermatosclerosis
      1. tapering of leg above ankle
        'inverted champagne bottle'
    3. haemosiderosis
      1. brown hyperpigmentation
        iron deposition in skin
    4. varicose veins
      1. previous DVT
  2. management
    1. compression stockings + elevation
      1. after ABPI to rule out PAD
    2. lifestyle/meds
    3. surgery
      1. ablation
      2. sclerotherapy
      3. stripping
  3. investigations
    1. CVD/diabetic risk factors
      1. HbA1c
      2. BP
      3. lipid profile
  4. incompetent valves -> stasis/insufficiency
3. Diabetic
  1. aetiology
    1. peripheral neuropathy
      1. reduced sensation/ proprioception
        damage to pressure areas
    2. PVD
      1. reduced healing
  2. symptoms/signs
    1. deep, painless ulcer
    2. on pressure area
      1. callous formation
    3. 'sock & glove' parasthesia
    4. Hx of previous ulcers & slow healing
  3. investigations
    1. random glucose/ HbA1c
    2. xray
    3. ABPI
  4. management
    1. ulcer
      1. debridement
      2. regular cleaning & dressing change
      3. antibiotics prn
      4. vascular referral
    2. lifestyle/meds
      1. BP control
      2. glycaemic conrtol
      3. cholesterol control
      4. education
      5. regular exercise
    3. long term
      1. Annual diabetic foot check

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Skin ulcers

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	Created by Laura Smitherman about 9 years ago