Ulceration (examination)

Examination of the leg should cover the following:

• palpation of pulses
• signs of venous disease
  • brawny skin
  • haemosiderin pigmentation
  • varicose eczema
  • atrophie blanche (patchy areas of ischemia)
  • lipodermatosclerosis.
• signs of arterial disease
  • shiny, hairless, pale and cool skin
• ulcer examination - describe where possible for every ulcer:
  • position
  • colour
  • tenderness
  • temperature
  • shape
  • size
  • specific to the ulcer:
    • base
    • edge
    • depth
    • discharge
    • relationship to other structures
    • lymph nodes
  • state of local tissues, including pulses - if cannot feel pulses then use Doppler
• surrounding region
  • for pain, oedema, erythema, warmth, induration, discoloration, maceration, dryness, scarring from previous wounds, hair pattern, gangrenous digits, clubbing, cyanosis, capillary refill, and varicose veins

Note:

• ulcer caused by vasculitis is suggested by irregular ulcer border, black necrosis, erythema, or bluish or purple discolorations of adjacent skin while pyoderma gangrenosum ulcers are usually painful with a violaceous border

Reference:

1. De Maeseneer MG et al. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022 Feb;63(2):184-267.