Ischemic ulcer

 

Ischemic ulcer

Inspection

Number Single or multiple
Site Tips of toes – Over pressure points
Shape Most often elliptical
Size and depth Vary from small, deep lesions, a few millimeters across, to large, flat ulcers 10 cm or more wide on lower leg

Usually very deep and may penetrate down to and through deep fascia tendons bone or even underlying joint

Floor Grey-yellow sloughs covering flat, pale, granulation tissue
Edge Punched out if no attempt at healing

Sloping if begin to heal

Margin Blue-grey color

No lipodermatosclerosis

Discharge Clear fluid – Serum – Pus
Surroundings
Arteries Distal pulse is invariably absent
Nerves There may be loss of superficial and deep sensations, weakness of movement and loss of reflexes if the ulcer is caused by neuropathy
Bones and joints May be exposed

Palpation

Lymph nodes Not normally enlarged
Base
Extent and motility May stuck to, or be part of, any underlying structure

And it is quite common to see bare bone, ligaments and tendons exposed in the base of an ischemic ulcer

Induration
Tenderness Very tender

Removing of dressing can cause exacerbation of pain lasts for several hours