Examination of an Ulcer

EXAMINATION OF AN ULCER

Adequately expose the ulcer.

Describe: Intro:  Site  Size  Tenderness

Define:  Shape  Depth

Edges:  Sloping  Punched out  Undermined  Rolled  Everted

Base:  Healthy  Sloughy  Avascular  Purulent  Necrotic  Underlying structures visible?

Surrounding Tissues:  Erythema/cellulitis.  Arterial &  Venous &  Neurological assessment.

Offer as appropriate:  Vascular examination  Venous examination  Neurological examination. Make a Diagnosis:

Is the ulcer painless?

NO YES

Neurological Cause Are foot pulses present?

YES NO

?Venous Probably ischaemic

NB: Beware of multiple pathologies, esp. in diabetic patients. (Peripheral Vascular Disease + Neurological Ulcers).

Glossary-Describing the Edge:  Flat Sloping Edge: healing ulcer, usually shallow, typical of a venous ulcer.  Punched-out/Vertical Edge: rapid death and sloughing of the full thickness skin without attempt at repair. Typical of neuropathic/vasculitic ulcers. Historically Syphilitic Ulcers, -now rare.  Undermined Edge: occur when infection supervenes in subcutaneous tissue, e.g. pressure sores. Historically caused by tuberculous ulcers.  Rolled Edge: develops when there is slow growth of tissue at the edge of the ulcer. Almost pathognomonic of BCC.  Everted/Heaped Edge: develops when tissue at the edge of the ulcer is growing quickly & spilling over normal skin. Usually SCC.