Clinical examination of ulcers

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 (1,2)

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 (1)

Reference:

• (1) Agale SV. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers 2013;vol. 2013, Article ID 413604, 9 pages
• (2) Adeyi A et al. Leg ulcers in older people: A review of management. BJMP 2009;2(3):21-28