May have a demarcation line of pale skin Venous stasis dermatitis; eczema or psoriasis against the darker red. Shingles or chickenpox Clear serous or yellow exudate will out Severe acne “pour” of the small openings, saturating the dressings Any trauma to the leg quickly Leg ulceration May have small blisters or large bullae White ethnicity unrelated to venous disease Insect, spider or animal bites Rapid increase of edema up the lower leg… Immuno-suppression often starts at the foot but can start in the calf Foreign objects in the skin (e.g. orthotic pins) Raised, swollen, tight shiny or glossy skin with Open wounds or ulcerations a stretche d appearance Skin is hot to Suggested Investigations: High WBC, increased ESR and C-reactive protein. Blood culture usually negative; swabs C&S usually negative unless necrotic tissue is swabbed (which is inappropriate) Management of Lower Leg Cellulitis Swabs for c&s not usually helpful if cellulitis is dry; if wet then should be done using LEVINE semi-quantitatitve method Levine Method for obtaining C&S laboratory swab 22 Cleanse wound thoroughly swab on granulation tissue enough pressure to extract fluid Turn swab 360 degrees on fluid (avoid slough or debris) swab in transport medium Mark line of demarcation on leg distally and proximally with soft-tip indelible marker (not pen) helps caregivers and patient to visualize if the infection spreads beyond the point of first assessment High compression, especially elastic systems, may be too painful to tolerate until the infection starts to respond to the antibiotic therapy. Do not stop compression entirely, because the edema will increase as a result of the cellulitis. May use appropriate lower mmHg compression such as two layers of tubular support bandage (e.g. Tubigrip) Leg elevation is important Treat any co-existing conditions such as venous ulcer, venous dermatitis or tinea pedis in addition to the systemic antibiotics In some individuals, discomfort can be soothed using a compress of Burosol solution or Burrow’s solution x 15-20 minutes available from some compounding pharmacies
May have a demarcation line of pale skin against the darker red. Clear serous or yellow exudate will “pour” out of the small openings, saturating the dressings quickly May have small blisters or large bullae unrelated to venous disease Rapid increase of edema up the lower leg… often starts at the foot but can start in the calf Raised, swollen, tight shiny or glossy skin with a stretche d appearance Skin is hot to Venous stasis dermatitis; eczema or psoriasis Shingles or chickenpox Severe acne Any trauma to the leg Leg ulceration White ethnicity Insect, spider or animal bites Immuno-suppression Foreign objects in the skin (e.g. orthotic pins) Open wounds or ulcerations Suggested Investigations: High WBC, increased ESR and C-reactive protein. Blood culture usually negative; swabs C&S usually negative unless necrotic tissue is swabbed (which is inappropriate) Management of Lower Leg Cellulitis Swabs for c&s not usually helpful if cellulitis is dry; if wet then should be done using LEVINE semi-quantitatitve method Levine Method for obtaining C&S laboratory swab 22 Cleanse wound thoroughly swab on granulation tissue enough pressure to extract fluid Turn swab 360 degrees on fluid (avoid slough or debris) swab in transport medium Mark line of demarcation on leg distally and proximally with soft-tip indelible marker (not pen) helps caregivers and patient to visualize if the infection spreads beyond the point of first assessment High compression, especially elastic systems, may be too painful to tolerate until the infection starts to respond to the antibiotic therapy. Do not stop compression entirely, because the edema will increase as a result of the cellulitis. May use appropriate lower mmHg compression such as two layers of tubular support bandage (e.g. Tubigrip) Leg elevation is important Treat any co-existing conditions such as venous ulcer, venous dermatitis or tinea pedis in addition to the systemic antibiotics In some individuals, discomfort can be soothed using a compress of Burosol solution or Burrow’s solution x 15-20 minutes available from some compounding pharmacies
Venous%20and%20Mixed%20Venous%20Leg%20Ulcers.docx