Ankle Brachial Pressure Index

A simple vascular assessment using a Doppler ultrasound to determine the ratio of the ankle to brachial systolic pressure.

Ankle Flare

Distention of small veins on the medial aspect of the foot. Also known as corona phlebectasia.

Arterial disease

Insufficient arterial blood flow through the arteries as a result of an accumulation of atherosclerosis.

Arterial ulcer

A chronic wound resulting from reduced arterial blood flow.

Atherosclerosis

Plaque formation on the lining of arteries which restricts arterial blood flow.

Atrophy Blanche

Describes an ivory-white area usually located on the medial aspect of the lower limb filled with telangiectasia and surrounded by hyperpigmentation. Sometimes referred to as livedoid vasculitis.

Basal Cell Carcinoma (BCC)

Fairly common slow growing and locally destructive tumour thought to arise from a subset of the basal cells in the epidermis occasionally seen on the lower leg. Initially the lesion is seen as a reddish, dome shaped nodule, as it expands the central area ulcerates leaving a raised rolled border, which may be mistaken for overgranulation. There are different variants of BCC which include nodular, cystic, rodent and sclerosing, resulting in a difference in appearance.

Dependent rubor

Is a fiery to dusky red colouration visible when the leg is in a dependant position but not when it is elevated above the level of the heart. This is caused by peripheral arterial disease and the extremity is cool to touch.

Dermatitis Artefact

Factitious ulcer or wounds caused by self-harming and as such may be quite bizarre in site and appearance due to being inflicted by certain agents such as rubber bands tight around the ankle (Negus 1985). Although rare, any unusual shaped wound should be considered suspicious and may be caused by the application of caustic materials in which case marked erythema may develop.

Doppler Ultrasound

A test using reflected sound waves to determine blood flow.

Duplex

Duplex ultrasound is a non-invasive evaluation of blood flow through arteries and veins.

Folliculitis

Inflammation of the hair follicles usually caused by bacterial or fungal infection.

Gaiter region

The region of the lower leg from just above the ankle to top of calf.

Haemosiderin

A pigment that is a product of haemolysis, an insoluble form of iron.

Haemosederin staining

Is the discolouration caused to the skin from the leaking of red blood cells into the tissue from the capillaries.

Hyperkeratosis

Abnormal thickening of the outer layer of the skin.

Induration

Increase in the fibrous element of tissue, loss of elasticity and pliability.

Intermittent claudication

The pain felt in an exercising muscle when the demand of arterial blood flow cannot be met due to arterial disease leading to a build up of metabolic waste in the muscle.

Lipodermatosclerosis

Fibrosis of subcutaneous tissue which feels hard and 'woody'.

Lymphoedema

Chronic swelling of the tissues due to the inability of the lymphatic system to effectively remove lymph fluid.

Mixed ulcer

Usually refers to an ulcer where there is an element of both arterial disease and venous hypertension.

Necrobiosis Lipoidca Diabetacorum

A necrotising skin condition that usually occurs in patients with diabetes. It presents as a dull raised area usually on the shins that evolves into a shiny sunken scar. There is telangiectasia with blood vessels easily visible under the skin.

Pyoderma Gangrenosum

This is an acute necrotising cutaneous ulceration, which may occur in the course of gastrointestinal disease such as ulcerative colitis and Crohn's disease. Or alternatively in patients with rheumatoid arthritis or myeloma. In about half of the cases no predisposing cause is found. The appearance demonstrates an active border, which is a deep reddish purple and the central portion is necrotic and ulcerated. A halo of erythema surrounds the lesion, which is often extremely painful. It is suggested that the tissue destruction is caused by a vasculitis although it is difficult to find evidence of this. Management involves specialist attention and treatment with anti-inflammatory drugs.

Squamous Cell Carcinoma (SCC)

A SCC is a malignant tumour derived from keratinocytes it is an aggressive tumour and metastasis may be generalised. Common areas for occurrence are on areas of skin damage or old scars. The appearance may be an opaque skin coloured fleshy papule, nodule or plaque, which is very often scaly due to keratin production. As a result, lesions may appear crusty and like a verucca but may also be eroded or nodular and frequently have a friable surface, which bleeds easily. A primary SCC presenting as ulceration has been described as SCC Per Priman (Negus 1985).

Telangiectasia (spider veins)

Small dilated blood vessels near the surface of the skin, often an indicator of a disturbance of the haemodynamics of venous return from the legs.

Varicose veins

Dilated swollen veins, which usually appear blue and may appear lumpy, bulging or twisted. They occur due to valve insufficiency where the valve fails to close due to damage or increased venous pressure. When the calf muscle contracts and directs venous blood flow into the deep conducting veins the one way valves open, as the muscles then relax the valve should close and prevent the backflow of venous blood. If the valve is damaged or subjected to abnormal pressures the valve fails to close and allows backflow of venous blood leading to dilation of the superficial vein.

Vasculitis

Inflammation of blood vessels and refers to a host of conditions with multiple causes and consequences depending on the vessels involved. The aetiology is poorly understood and it is thought there may be some genetic factors. Vasculitis can also be secondary to other diseases and also factors such as viral, bacterial or abnormal drug reactions and termed Hypersensitivity Vasculitis. This is an immune response to an exogenous substance most often a drug. It primarily affects arterioles and venules and the inflammation of the vessel results in necrosis.

Venous hypertension

The development of an abnormally high pressure within the superficial venous of the legs, which occurs as a result of insufficient venous return. This leads to a failure to remove metabolic waste products from the tissue bed leading to congestion, which inhibits arterial blood flow containing essential nutrients from entering the tissue bed.

Venous Ulcer

A chronic wound which occurs in an area of venous hypertension, due to the poorly nourished tissues as a result of venous hypertension.