venous ulcer.pptx

Describes leg ulcers caused due to venous insufficiency

1. Ve n o u s u l c e r By M u w e e s i Is m a i l D i p O P M U I A H M S

2. Ou t l i n e De f i n i t i o n a n d i n t r o d u c t i o n R isk factors P athophysiology Si g n s a nd symptoms D iagnosis/ i n v e s t i g a t i o n s T reatment Co m p l i c a t i o n s

3. De f i ntion and introduction Ve n o u s u lcer is an ulcer due to ambulatory chronic venous hypertension I ts due to varicose veins ie the long saphenous v e i n s and short saphenous/ p e r f o r a t o r s v e i n s o r a p o s t phlebitic limb P ost phlebitic limb consists of veins that have been partially recanalised following a DVT which c a u s e s i n c r e ased venous pressure around the ankle through perforators I ts common around the ankles(gait e r’ s z o n e) I ts m o s t c o m m o n i n w o m e n w i t h v a r i c o s e v e i n s

4. Ri sk factors Va r i c o s e v eins H istory of DVT in the legs O l d a g e , b e i n g t a l l, b e i n g f e m a l e F amily history of venous insufficienc y O besity S mok i n

5. p a t h o p h y s i o l o g y V enous ulcer arise s from dysfunction of venous valves allowing back flow causing increases venous pressure. The imbalance between arterial and venous pressures leads to pooling. Venous stretching allows extravasation of proteins, inflammatory exudates, occlusion with ischaemia and free radical release hence contributing to ulceration and poor wound healing

6. Si g n s a n d s ymptoms Ul c e r i n i t i a l l y p a i n f u l but later becomes painless U lcer is often vertically oval with s l o p i n g e d g e s C ommonly located on medial side of ankle but no t a b o ve the middle athird of leg F loor is covered with pale or often without any granulation tissue T enderness is often seen at the base of the ulcer. I t doesnt pentrate deep fascia Edema P r e s e n c e o f varicosities Venous dermatitis I nguinal lymph nodes are often enlarged. Ul c e r h e a l s b u t o f t e n r eforms again. S c a r r ing i s c o m m o n d u e t o r e p e a t e d h e a l i n g a n d r e c u r r e n t u l c e r f o r m a t i o n . T his unstable s c a r ing of long du r a t i o n m a y l e a d t o s q u am o u s c e e l l c a r c i n o m a .(Marjolin ulcer)

7. I nvestigatins Colour duplex Ultrasonography ( gold standard in venous disease) Xray ( R/O osteomyelitis) Biopsy and histology (suspected malignant) General and sy s tem i c e x a m i n a t i o n Venogram

8. G enen e r a l p r i n c i p l e s of managing ulcers Ensure adequate and balanced perfusion Manage wound (debridement, dressing) Treat associated infection Ensure adequate nutrition Find and treat cause Find and treat associated and risk factors Educate the patient Follow up and protect from recurrence

9. Tr e a t m e n t o f v e n o u s u l c e r s Bisgaard regimen (4Es) Education Elevation Elastic compression Evaluation Artificial skin (may be combined c comp) Surgical correction of superficial venous reflux

10. C o m p l i c at i o n s Ch r o n i c p a i n I mpaired mobilit y (often due to pain) I nfection eg osteomyelitis and septicemia A llergic contact dermatitis M alignancy leading to amputat i o n a n d d e a th cellulitis

11. Th a n k y o u f o r your attention………..