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Chronic Leg Ulcers: Atef Abdel Hameed, MD Professor of Vascular Surgery Ain Shams University

This document discusses chronic leg ulcers, including their definition, causes, examination, and management. Chronic leg ulcers are breaks in the skin or mucous membrane that last more than 4-6 weeks. The most common causes are venous issues, arterial issues, diabetes neuropathy, and infection. Doctors examine the ulcer's shape, size, edges, floor, base, margin, and discharge to determine the cause. Management involves local wound treatment, controlling infection, addressing pain, improving general health, treating the underlying cause, and sometimes surgery.

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Amr Abdelghaffar
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141 views21 pages

Chronic Leg Ulcers: Atef Abdel Hameed, MD Professor of Vascular Surgery Ain Shams University

This document discusses chronic leg ulcers, including their definition, causes, examination, and management. Chronic leg ulcers are breaks in the skin or mucous membrane that last more than 4-6 weeks. The most common causes are venous issues, arterial issues, diabetes neuropathy, and infection. Doctors examine the ulcer's shape, size, edges, floor, base, margin, and discharge to determine the cause. Management involves local wound treatment, controlling infection, addressing pain, improving general health, treating the underlying cause, and sometimes surgery.

Uploaded by

Amr Abdelghaffar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Chronic Leg Ulcers

Atef Abdel Hameed, MD


Professor of Vascular Surgery
Ain Shams University
The Origin of the word (ULCER)

• Old French : Ulcere ... Vulgar

• Latin : Ulcus .. Painful sore

• Greek : Elkes.. Wound sore


Definition of Ulcer

A break in the continuity of the covering epithelium,


either skin or mucous membrane due to molecular
death.
(Loss of surface tissue, disintegration and necrosis of epithelial tissue)

(Epidermis & at least part of dermis)


Chronic ulcer

• More than 4-6 weeks

• Results when sequel of repair is disturbed at one or more


stages of inflammation, proliferation, re-epithelization or
remodeling
How to examine an ulcer

• Shape (Regular/Irregular)
• Site
• Size (Extent)
• Number
How to examine an ulcer

• Edge
• Floor
• Base
• Margin
• Discharge
How to examine an ulcer

• Temperature of surrounding skin


• Regional lymphadenopathy
• Peripheral pulsations
• Peripheral sensation
Edge

• Slopping (Healing)
• Undermined (T.B)
• Punched out
(Trophic/syphilitic)
• Rolled out (Rodent)
• Everted (Malignant)
Floor

• Sloughed
• Granulating (healthy/poor)
• Necrotic
• Gangrenous
Base

• Hard / Soft
• Fixed / Mobile
• Underlying (Muscle / Bone)
Margin

• Regular / Irregular
• Hyperemic / pigmented
• Temperature
Causes of chronic leg ulcers
• Venous
• Arterial
• Mixed (Arterial & venous)
• Neuropathic (DM)
• Infective
• TB
• Traumatic
• Connective tissue disorders (Vasculitis)
• Pressure ulcers (Bed sores)
• Miscellaneous (Drugs / metabolic)
Venous ulcer

• Most common (45-60%)


• Main pathology is VENOUS HYPERTENTION
• Venous stasis
• Reflux (superficial / Deep)
• Obstruction
• Varicose veins (primary / secondary)
• Postphlebitic syndrome
• Pigmentation / eczema / lipodermatosclerosis
Venous ulcer

• At gaiter area
• Single or multiple
• Edge : slopping
• Floor : granulating or necrotic
• Base : subcutaneous tissue
• Margin : warm / pigmented
• Discharge : serous
• Peripheral pulsations : intact
• Lymph nodes : according to infection
Ischemic ulcer

• 10-15%
• Toes / feet / heel
• Edge : punched out (Endarteritis obliterans)
• Floor (sloughed / poor granulation/ gangrenous)
• Base (bone)
• Margin (atrophic / blackish)
• Peripheral pulsations (weak / absent)
• Lymph nodes
Neuropathic ulcer

• 15-25%
• Most commonly with DM
• Peripheral neuropathy (Sensory / motor)
• At pressure areas
• Edge : slopping / punched out
• Floor : granulating
• Base : tendons / deformed bones
• Discharge : mostly NO
• Pulsations : intact / absent
• Peripheral sensation : absent
Wegner classification of diabetic foot ulcer
WIFI Classification system
Malignant ulcer

• Uncommon
• DE NoVo / on top
• Edge : everted
• Floor : necrotic
• Base : fixed
• Discharge : serosanguinous
• Pulsations : intact
Management

• Local treatment
• Control of infection
• Pain management
• General condition
• Treatment of the cause
• Dramatic solutions
THANK YOU

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