ulceration (examination)

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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:

Last reviewed 01/2018

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