What’s the difference between a venous leg ulcer, an arterial leg ulcer and a mixed leg ulcer?
The three most common causes of leg ulceration are linked to disorders of the circulation. The vast majority (~70%) of lower-extremity ulcers are caused by chronic venous insufficiency (CVI), followed by arterial disease (~20%) or a combination of venous and arterial disease (15-21%)⁽¹⁾⁽²⁾.
Why is it essential to understand the wound aetiology? The selection of safe and effective leg ulcer treatment is dependent on the correct identification of the wound aetiology. Assessing whether arterial blood flow of the limb is impaired is an essential part of the initial assessment. It is also important to look out for any local barriers to healing, such as elevated levels of matrix metalloproteases and impaired blood vessel network⁽³⁾⁽⁴⁾.
DID YOU KNOW? - The ankle brachial pressure index (ABPI)
In all patients presenting with leg ulceration, the APBI should be calculated using a Doppler device or other screening device before selecting a treatment option. In short, the systolic blood pressure at the ankle is divided by that at the arm. A low ABPI is considered to be indicative of blocked arteries du to peripheral arterial disease (PAD).
- HardingK, Dowsett C, Fias L, et al. Simplifying Venous Leg Ulcer Management.Recommendations from an Expert Working Group. https://tinyurl.com/y4h5k6gd(accessed 31 July 2020)
- Neil K,Turnbull K. Use of specialist knowledge and experience to manage patients withmixed aetiology leg ulcers. J Wound Care. 2012; 21(4):168–74
- LázaroJL, Izzo V, Meaume S et al. Elevated levels or matrix metalloproteinases andchronic wound healing: an updated review of clinical evidence. J Wound Care.2016: 25(5): 277–87. https://doi.org/10.12968/jowc.2016.25.5.277
- Honnegowda TM, Kumar P, Udupa EG et al. Role of angiogenesis and angiogenic factorsin acute and chronic wound healing. Plast Aesthet Res. 2015; 2:243-9