A 68-year-old woman with a leg ulcer

Published on 10/04/2015 by admin

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Last modified 10/04/2015

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Problem 25 A 68-year-old woman with a leg ulcer

She is not a diabetic, but does take tablets for her blood pressure. She is not sure what these are. She is on no other medications. She has had no other illnesses of note, but has had varicose veins ever since the birth of her children. On further questioning, she reveals that the left leg was very swollen for 2 or 3 months after her third pregnancy but she never had any tests to see why. This has been her ‘bad leg’ ever since. Her leg ulcer is shown in Figure 25.1.

In addition to what is shown in the photograph, both legs show evidence of chronic venous insufficiency. There is loss of subcutaneous fat, and this atrophy has caused an ‘inverted champagne bottle appearance’. There is pigmentation above each ankle. There are no ulcers on the feet or toes.

On general examination she is mildly obese and has a blood pressure of 160/110 mmHg. The rest of the cardiorespiratory and abdominal examination is unremarkable. Her left leg shows varicosities in the distribution of the long saphenous vein. The right leg is similarly affected with varicosities and changes of chronic venous insufficiency in the lower third of the calf. You note the skin around the ulcer is mildly inflamed and tender and you think the ulcer is infected. The peripheral pulses and neurological exam of the lower limbs are normal.