Venous leg ulcers
- Around 95 per cent of leg ulcers are venous.
- Arterial supply to the leg is usually normal.
- Varicose veins are often seen and brown and/or black staining of the skin or eczematous change around the ulcer.
- Risk of secondary infection with pain, inflammation, purulent discharge and crusting.
- Exclude arterial problem with Doppler.
- Advise to stop smoking. Treat underlying cause.
- For purely venous ulcers, exercise, elevation at rest and compression bandages.
- Careful cleansing and debridement of the ulcer.
- Antibiotics such as flucloxacillin for infection.
- Skin grafting for large or persistent ulcers.
- More common in the elderly.
- Feet cold, bluish. Common on heels and toes.
- Sharply defined with surrounding skin pale and shiny.
- Peripheral pulses reduced.
- Pain on exercise and when the leg is elevated.
- Check that Doppler indicates arterial ulceration (<0.6).
- Refer urgently if Doppler <0.5 or monophasic.
- Retention bandaging only. Avoid tight clothing.
- Treat with systemic antibiotics if necessary.
Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire.