Comparison of features of arterial versus venous ulceration

assessment criteria

venous disease

arterial disease

presenting history, physical and social risk factors

previous history of DVT
varicose veins
reduced mobility
traumatic injury to the lower leg
obesity
pregnancy
nonhealing ulceration
recurrent phlebitis
previous vein surgery

diabetes
hypertension
smoking
previous history of vascular disease
obesity
inability to elevate limb

position of ulceration

gaiter area of the leg
common site is medial aspect

lateral malleolus and tibial area are common sites as well as toes and feet
over pressure points

ain

throbbing, aching, and heavy feeling in legs
improves with elevation and rest

intermittent claudication
can be worse at night and at rest
improves with dependency

ulcer characteristics

shallow with flat margins
often presents with slough at the base with granulation tissue
moderate to heavy exudate

punched out, occasionally deep
irregular in shape
unhealthy appearance of wound bed
presence of necrotic tissue or fixed slough
low exudate unless ulcers infected

condition of the lower leg

haemosiderin staining
thickening and fibrosis
dilated veins at the ankle
crusty, dry, and hyperkeratotic skin
eczematous, itchy skin
pedal pulses present
normal capillary refill (less than three seconds)
limb oedema is common

thin, shiny, and dry skin
reduced or no hair on lower leg
skin feels cooler to touch
pallor on leg elevation
absence or weak pedal pulses
delayed capillary refill (greater than three seconds)
development of gangrene