Aspects Location

Arterial ulcer Anywhere on the leg; usually distal to impaired arterial supply, between toes or tips of toes, over phalangeal heads, around lateral malleolus, or at sites subjected to trauma or rubbing of footwear. May be superficial or deep. Margins are even, sharply demarcated, and punched out. Usually very painful; pain is often relieved by dependent leg position and aggravated by elevation. Periwound tissue may appear blanched or purpuric and is often shiny and tight; loss of hair at ankle or foot. Minimum exudate May or may not have swelling (edema) of the lower extremities

Venous ulcer Betw the knee and the ankle, with medial and lateral malleolus the most common sites.

Depth Appearance

Usually superficial Large with irregular margins May be painless; however, pain varies unpredictably and often is relieved with leg elevation. Hyperpigmentation, dermatitis, and lipodermatosclerosis.

Tenderness

Surrounding skin

Exudates Edema

Moderate to heavy exudate. Almost always there will be edema (swelling of the leg) and in fact, edema is usually the FIRST thing you will find. Normal pulse. Normal.

Pulse Temperature

Faint to absent pedal pulse. Skin is often cool or cold to touch.

INTERPRETING ANKLE-BRACHIAL RESULTS Use the following guideline to interpret the ABI results:

* 0.9 to 1 -normal * 0.75 to 0.9-moderate disease * 0.5 to 0.75-severe disease * below 0.5-limb-threatening disease. Physical examination of vascular cases Inspection: Colour White as marble(blanching)/ degrees of redness or blueness/ purple-blue cyanosed appearance/ black (gangrene) Mottling Skin The Hairless Shiny Scaly Bruises/scars Presence of ulcers/ gangrene Edema Nail changes Interdigital infection

vascular angle: Buergers angle The angle to which the leg has to be raised b4 it turns white. Normal limb: pink even when raised 90degree. <20degree: severe ischemia

Capillary refill time After elevating the legs, pt is asked to sit up n dangle their feet over the side of the couch. Ischemic legs will slowly turn white pink purple-red colour (deO2ated blood filling the dilated capillaries) Time taken to change frm white pink : CRT A red-purple foot: indicates severe ischemia Venous filling Guttering of the veins