Question

A patient presents with a 5x2x.4cm wound on the left lower extremity. The lower limb is edematous and the skin in the malleolar area has a a reddish brown discoloration. The foot is warm to the touch with palpable pulses. Hair is present on the leg and toes. The patient rates his pain a 6/10 when he is standing or sitting. The wound drains to the point that the inside of the patients shoe gets wet. An ABI of .8 is noted. What is the most likely wound etiology?

Answer 1

The wound etiology is most likely venous insufficiency, leading to a venous stasis ulcer due to the presentation of edema, reddish-brown discoloration, warmth with palpable pulses, and pain that worsens with dependency.

Step-by-step explanation:

The patient presents with a wound characterized by a reddish brown discoloration in the malleolar area, edema, warmth, palpable pulses, and hair present on the leg and toes. They rate pain as 6/10 while standing or sitting, and there is significant drainage noted. The Ankle Brachial Index (ABI) is .8, which is indicative of peripheral arterial disease (PAD) but not severe obstruction. Considering the symptoms and ABI value, the most likely wound etiology seems to be venous insufficiency, which can cause venous stasis ulcers that typically present with edema, hyperpigmentation (reddish brown discoloration), and moderate pain that increases with dependency.

This condition is associated with impaired venous return, often resulting from deep vein thrombosis (DVT), varicose veins, or other factors leading to chronic venous insufficiency. Furthermore, the presence of hair on the toes and the warmth of the foot suggest that arterial perfusion is sufficient, thus reinforcing the diagnosis of a venous ulcer rather than an arterial ulcer, which would typically present with hair loss, cool skin, and a lower ABI.