Differentiating Ulcer Types

Ulcer characteristics

Venous

Arterial

Diabetic
Location Most often around ankle, medial malliolus (from instep to above the ankle). Most often on tips of toes; distal to impaired arterial supply. Most often on foot, at area of trauma or on weight-bearing surface; may be between toes.
Ulcer base "Beefy" red; may be shallow or deep. Pale, gray, or yellow, with no evidence of new tissue growth; may be shallow or deep. Often has deep necrotic area that’s undetected until it is opened surgically; may be dry.
Border Irregular Regular; if caused by trauma, ulcer border may be irregular and will conform to injury. Undefined; ulcer may be small at surface and have large subcutaneous abscess.
Drainage May be copious. Usually minimal Varies. An infected ulcer may have purulent drainage; others may have no drainage.
Pain Aching, stinging, burning from exposed superficial nerves. Very painful (burning, throbbing, stabbing sensation) unless neuropathy is present. No sensation or constant or intermittent numbness or burning.
Surrounding skin May be ruddy, edematous, maurated. Pale or gray or dry; black eschar; cool; may be thin; little or no edema. Dry, thin.
Pulses Present, but may be difficult to palpate if edema is present. Absent Present
Treatment Leg elevation Compression therapy at least 30 mmHg at ankle

 

 

Topical therapy goals: absorb, exudate maintain moist wound surface (e.g. alginate, foam, hydrocolloid dressings)
  • No tobacco
  • No caffeine
  • No constrictive garments
  • Avoid cold
  • Hydration
  • Wear appropriate footwear at all times

Topical therapy:
Dry infected necrotic wound; keep dry
Open wound:
Moist wound healing
Use nonocclusive dressings

 Pressure relief for heal ulcers
Appropriate footwear
Tight blood sugar control

 

 

Topical therapy:
Use occlusive dressings cautiously
Use dressing to absorb exudate
Keep surface moist

ACWCP - 1998