Venous Ulcers

Front 1

Venous ulcer MC site

Patho

Back 1

medial distal leg

Blood pools, pressure prevent fresh blood from reaching site

Front 2

Venous vs Arterial

Back 2

Venous medial, Arterial lateral pulseless cool bony prominence

Front 3

TX of venous

Back 3

Boot or stocking compression

Artifial growth factors on bandage. Artificial skin with cells to promote new skin growth

Debridement

Front 4

Define chronic ulcer

Back 4

chronic ulcer >12 weeks

Front 5

Discharge
Serous
Serous Anguinous
Purulent

Back 5

Serous-healing
Serousanguinous-healing
Purulent-infected

Front 6

HISTORY OF PRESENT ILLNESS: This is a 52-year-old native American-Indian man with hypertension, chronic intermittent bipedal edema, and recurrent leg venous ulcers, who was admitted on 01/27/09 for scheduled vascular surgery per Dr. X. I was consulted for nonhealing right ankle stasis ulcer. There is a concern that the patient had a low-grade fever of 100.2 early this morning. The patient otherwise feels well. He was not even aware of the fever. He does have some ankle pain, worse on the right than the left. Old medical records were reviewed. He has multiple hospitalizations for leg cellulitis. Multiple wound cultures have repeatedly grown Pseudomonas, Enterococcus, and Stenotrophomonas in the past. Klebsiella and Enterobacter have also grown in the few wound cultures at some point. The patient has been following up at the wound center as an outpatient and was referred to Dr. X for definitive surgical management.

Back 6

SKIN: There is hyperpigmentation involving the distal calf of both legs. There is an open wound on the right medial
malleolar area measuring 9 x 5cm with minimal serous drainage. Periwound is hyperpigmented with a hint of erythema extending proximally to the medial aspect, distal third of the right lower leg. There is warmth, but minimal tenderness on palpation of this area. There is also a wound on the right lateral malleolar area measuring 4 x 3 cm, another open wound on the left medial malleolar area measuring 7 x 4 cm. Wound edges are poorly defined.

Front 7

2. Right leg/ankle cellulitis.
3. Chronic recurrent bilateral ankle venous ulcers.
4. Multiple previous wound cultures positive for Pseudomonas, Enterococcus, and Stenotrophomonas.
5. Hypertension.

RECOMMENDATIONS:
1. We have ordered 2 sets of blood cultures.
2. Agree with daptomycin and Primaxin IV.
3. Follow up result of wound cultures.

Back 7

REASON FOR THE CONSULT: Nonhealing right ankle stasis ulcer.
1. We have ordered 2 sets of blood cultures.
2. Agree with daptomycin and Primaxin IV.
3. Follow up result of wound cultures.
4. I will order an MRI of the right ankle to check for underlying osteomyelitis.