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Module 5.3: Lower Limb Ulcers

PATIENT ASSESSMENT

A person with a lower limb ulceration should receive a comprehensive, holistic assessment to achieve an accurate diagnosis to then establish an appropriate management plan (Atkins & Tickle, 2016; NWCSP, 2020). Furthermore, an assessment should be carried out by a health care professional trained in leg ulcer management (NICE, 2015).

General assessment

  • Looking at the patient as a whole, including lifestyle and medical history
  • Comorbidities
  • Previous limb surgery/trauma
  • Previous treatment and outcomes
  • Family history
  • Medication history
  • Nutrition and hydration
  • Presenting symptoms
  • Mobility and dexterity
  • Pain and analgesic needs
  • Knowledge and understanding

(Atkins & Tickle, 2016; Wounds UK BPS, 2016; Evans et al., 2019)

Physiological factors

  • Lifestyle
  • Occupation
  • Quality of life
  • Social activity
  • Sleep patterns
  • Care and support network
  • Expectation of treatment
  • Weight/BMI

(Atkins & Tickle, 2016; Wounds UK, 2016, Evans et al., 2019, NWCSP, 2020)

Leg assessment

A comprehensive lower limb assessment is essential. Peripheral perfusion and a complete vascular assessment are a fundamental requirement for leg ulcer management (Wounds UK BPS, 2016; Evans et al., 2019; NWCSP, 2020). This should include a use of a Doppler to analyse arterial flow to record ankle brachial pressure index (ABPI). This will assist in ascertaining any peripheral arterial disease (Atkins & Tickle, 2016).

Limb related factors

  • Ankle brachial pressure index (ABPI)
  • Oedema below and/or above the knee
  • Limb size and shape
  • Mobility and ankle movement
  • Colour and condition of the skin
  • Temperature
  • Neuropathic assessment for sensation changes

Vascular related factors

  • ABPI to check for arterial insufficiency
  • Vascular history
  • Limb temperature
  • Erythema, pallor and/or cyanosis
  • History of deep vein thrombosis

(Atkins & Tickle, 2016; Wounds UK, 2016; Evans et al., 2019)

Skin related factors

  • Hydration
  • Skin changes e.g. haemosiderin staining
  • Lipodermatosclerosis
  • Skin folds
  • Skin allergies/sensitivities
  • Ulceration, include size, depth, location, exudates levels, signs of infection etc.
  • Scar tissue

(Atkins & Tickle, 2016)