see also [[Acute limb ischaemia]] , [[Wound management|wound healing]] see: [Wound care incredibly simple: treatment of vascular ulcers](x-devonthink-item://4A0A6619-A8AE-4C2A-95DD-D3D26DECF493?page=136), [Diabetic foot ulcers](x-devonthink-item://4A0A6619-A8AE-4C2A-95DD-D3D26DECF493?page=142) | | Arterial | Venous | | ---------------- | ---------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | pain? | painful | mildly painful | | location | - anterior shin<br>- over malleoli<br>- heel<br>- plantar toe joints | - just above medial or lateral malleoli<br>most common on medial aspect of ankle | | appearance | "punched out," well defined<br>small, deep<br>regular margin<br>floor: slough / necrotic | large, shallow, vertically oval<br>irregular margin<br>floor: granulation, moist | | chronic features | - pale leg<br>- cool leg<br>- "trophic" changes hairless, thin shiny skin<br>- dependent rubor | features of chronic venous insufficiency:<br>- varicose veins<br>- lipodermatosclerosis / hemosiderin deposition<br>- venous eczema | | risk factors | - old age<br>- smoking<br>- DM<br>- HTN<br>- HLD | - incompetent valves<br>- inadequate calf muscle function | | example | ![[Pasted image 20240429221518.png]] | ![[Pasted image 20240429221608.png]] | | treatment | - bypass or angioplasty<br>- keep wound dry and protected from pressure<br>- do not soak | - conrol oedema<br>- limb elevation<br>- compression bandages<br>- occlusive dressings to promote moist wound healing, growth of granulation tissue, and re-epithelisation | # Venous Ulcer / venous insufficiency ![[Pasted image 20240429223522.png]] also: - fibrotic skin aka *lipodermatosclerosis* → eventually forms shiny, taut appearance - eczema (venous dermatitis) . skin over scar tissue and edematous tissue is fragile. - telangiectasia. superficial veins just below the skin's surface become dilated, producing webline appearance on the skin - *hemosiderosis*. brown discoloration of the skin occurs just above the ankle as a result of hemosiderin deposits ![[Pasted image 20240429223803.png]] ![[Pasted image 20240429223835.png]] ![[Pasted image 20240429223907.png]] # arterial ulcer **developent of an arterial ulcer** 1. arterial flow diminished, usually from atherosclerosis 2. trauma occurs to an area with arterial insufficiency 3. reduced blood flow impairs healing, and a chronic wound results ![[Pasted image 20240429223148.png|ischaemic forefoot]] ![[Pasted image 20240429224147.png]] *dependent rubor* is a sign of chronic arterial insufficiency - elevate foot, if foot is ischaemic, will become pale - lower foot to dependent position: ischaemic skin becomes deep red as the tissue fills with blood. signifies severe tissue ischaemia. ![[Pasted image 20240429224352.png]] # Diabetic foot ulcer # pressure ulcer # Ankle-brachial index (ABI) - \>0.9 normal - 0.71-0.9 mild arterial insufficiency - 0-0.4 severe arterial insufficiency