Question

Describe the management of Mixed ulcers

Answer 1

Ans) Mixed ulcers are the result of a combination of both venous and arterial disease.
- Mixed aetiology ulcers are complex and can change their character rapidly e.g. when the arterial disease is rapidly progressive.
- If the arterial disease is left untreated because it is progressive the arterial problem will eventually be the major factor to consider when making treatment decisions.

TREATMENT OF MIXED ULCERS:

- If the underlying medical cause of the ulcer is known then it is essential to treat it.

MANAGEMENT OF MIXED AETIOLOGY ULCER:

• Hypertension will respond to medication and weight reduction may also be implemented.
• If exercise is possible a minimal regimen of moderate exercise will help improve the blood flow in the legs.
• If the patient has diabetes then their blood sugar levels should be closely monitored and their treatment reassessed.
• In the presence of venous incompetence, varicose vein surgery is effective in patients who can still receive this treatment.

PATIENT & FAMILY HEALTH TEACHING:

1) PERSONAL HYGIENE:

- Because of the high risk of infection patients should be persuaded to keep themselves and their environment as clean as possible.

- Regular washing and the use of clean clothes may be more difficult in older and immobile patients.

- The ulcers and the surrounding skin must never be touched without first washing the hands.

2) SKIN CARE:

- Skin problems can occur with both venous and arterial disease and the skin needs to be protected as much as possible from the effects of trauma.

- Patients with venous ulcers often suffer from local tissue ischaemia and trophic problems: atrophie blanche, varicose eczema, pigmented purpuric dermatitis, etc.

- Patients should report any itching and discomfort which can be alleviated by the use of paraben-free, hypoallergenic emollients.

RECOMMENDATIONS:

- Patients should be encouraged to eat a healthy diet that contains a variety of fresh fruits, vegetables, dairy, grains and proteins and drink plenty of fluids.

- Patients should be as active as possible and carry out their normal activities. Walking should be encouraged but patients should not stand still or sit for long periods.

- For venous origin ulcers only the leg should be raised at night. This may be achieved by putting some pillows under the end of the mattress.