LymphnVascular

Hypertensive ulcers

  • It usually occurs in patients with blood pressure that is long standing and poorly controlled.
  • Also associated with Diabetes Mellitus
  • It affects women more than men.
  • Commonly occur on the outer aspect of back of the lower leg just above the ankle. Over the Achilles tendon is another site of occurrence.
  • Ulcers typically occur in the absence of significant arterial or venous disease.

Diagnosis:

  • Strong, excruciating pain
  • On Physical examination – solitary or symmetrical, affecting same site on both lower legs
  • Red-purple inflamed ulcer edge
  • Irregular shape
  • Deep, exposing underlying tendons.
  • Failure to respond to usual treatments for leg ulcers.
  • Blood tests show elevated C-reactive protein and white blood cells.

Treatment:

  • Better control of blood pressure
  • Surgical debridement of the ulcer together with compression therapy, vacuum assisted closure.
  • In case of large ulcers – skin grafting.
  • Pain relief – Paracetamol and Non-steroidal anti-inflammatory drugs or opiates in case of severe pain.
  • Antibiotics may be required for secondary bacterial infection.
Preventive measures:
  • Stop smoking
  • Compression stockings
  • Protection from Trauma

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