Expansion
Base, edge, depth, discharge, site and the surrounding skin
Expansion
Features to describe
- Site
- Size and shape
- Edge: sloping (healing or venous), punched out (arterial, neuropathic, syphilitic), undermined (tuberculosis, pressure), rolled (basal cell carcinoma), everted (squamous cell carcinoma)
- Base: granulation tissue, slough, necrosis, exposed tendon or bone
- Depth
- Discharge: serous, purulent, blood
- Surrounding skin: pigmentation, eczema, lipodermatosclerosis, cellulitis, callus
- Sensation around and within
- Pulses, capillary refill, and the ankle brachial pressure index
- Lymph nodes
The three common leg ulcers
| Venous | Arterial | Neuropathic | |
|---|---|---|---|
| Site | Gaiter area, medial malleolus | Pressure points, toes, heel, lateral | Plantar pressure points |
| Edge | Sloping, irregular | Punched out, regular | Punched out |
| Base | Granulating | Necrotic, pale | Often deep, may probe to bone |
| Pain | Aching, better on elevation | Severe, worse on elevation | Painless |
| Surrounding skin | Haemosiderin, varicose eczema, lipodermatosclerosis | Shiny, hairless, cool | Callus, warm, good pulses |
| Pulses | Present | Absent | Usually present |
Compression is the treatment of venous ulceration but is contraindicated if the ankle brachial pressure index is below 0.8, which is why the arterial assessment must precede it.