ulceration (examination)

Last reviewed 01/2018

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