Q: Can you help us identify and differentiate lower extremity ulcers?
A: These ulcers are the three most common lower extremity wounds:
Venous
Location: Medial aspect lower leg between ankles and knees
Wound characteristics: Irregular wound edges, dark red granular tissue, moderate to heavy drainage
Patient assessment: Firm edema, dilated superficial veins; dry, thin skin; evidence of healed ulcers; hemosiderin staining; lipodermatosclerosis; feet warm; good pulses
Pain: Dull aching; severity variable
Arterial
Location: Between toes or tips of toes, lateral malleolus or at sites subjected to trauma or rubbing
Wound characteristics: Even wound margins, gangrene or necrosis, deep pale wound bed, blanched or purpuric periwound tissue, minimal exudate
Patient assessment: Thin, shiny, dry skin; hair loss on ankle and foot; thickened toenails; pallor on elevation and dependent rubor, cyanosis, foot cool to touch with absent or diminished pulses
Pain: Intermittent claudication, nocturnal or rest pain, worsening severity
Diabetic
Location: On plantar aspect of foot over metatarsal heads, under heel, tips of toes, areas exposed to repetitive trauma
Wound characteristics: Even wound margins, deep wound bed, calloused wound perimeter, granular tissue
present unless PVD is present, low to moderate drainage
Patient assessment: Diminished or absent sensation in foot, foot deformities, palpable pulses, warm foot, subcutaneous fat atrophy
Pain: Burning/tingling, shooting pain, severity variable
Please send your wound treatment-related questions to Donna Sardina at [email protected].
From the February 01, 2011 Issue of McKnight's Long-Term Care News
