Chronic wound ® ulcer, lesion

• Venous ulcer - ­ stagnation; found at lower calf
• Arterial ulcer - found at pressure points
• Marjolin's ulcer - chronic ulcer/ scar ® squamous cell carcinoma
• Lower leg ulcer - must check veins (varicose), arteries (pulses), neurology (DM, IV prolapse) ® neurovascular exam
• Note: Hansen's disease (leprosy) - causes peripheral neuritis
• Hyperpigmentation - venous stasis ® accumulation of haemosiderrin (\ confirms venous system involvement)
• Arterial involvement (chronic) - wasted muscle, ¯ hair, ¯ vitality of skin
• Pt with chronic wound may have marked thickening of skin \ "Cannot feel dorsalis pedis adequately \ not clear whether apparent absence of pulse due to thickening of skin or true absence of pulse"

Acute wound ® usually traumatic

Discharge ® (1) Serous (2) Sanguinous (3) Purulent

• 3 S's ® Stand up, Site, System (long/ short saphenous)
• Complications (PUO) ® Pigmentation/ Pain, Ulcer, Oedema
• Tourniquet test ® know reason for performing (test incompetence), rubber tube (not band), venous not arterial tourniquet, clamp on lateral aspect leg, Pt to advise is any pain

• Loss - hair, skin vitality, muscle size (atrophy)
• Ulceration of pressure points
• Ischaemia
• Gangrene (1) Dry - slow ¯ blood supply, no inflammation (2) Wet - eg. DM, neuritis, occlusion - inflammation
• Pulses - ALL (may have generalised disease with local manifestations \ if radial pulse strong, still need to test brachial)
• Auscultate heart/ Bruit
• Abdomen - AAA?

Layers of SCALP ® Skin Cutaneous, Aponeurosis, Loose areolar, Pericranium