A 55-year-old woman presents with chronic leg ulcer at the medial gaiter area (just above medial malleolus). The ulcer has sloping edges, surrounding lipodermatosclerosis, and haemosiderin deposits. What is the MOST likely aetiology and the initial management?
- A Venous ulcer; four-layer compression bandaging after excluding significant arterial disease (ABPI >0.8) ✓
- B Arterial ulcer; ankle-brachial pressure index measurement and revascularisation
- C Neuropathic ulcer; off-loading footwear and glycaemic control
- D Marjolin's ulcer; biopsy and wide local excision
Correct answer: A. Venous ulcer; four-layer compression bandaging after excluding significant arterial disease (ABPI >0.8)
Explanation
This presentation — medial gaiter area ulceration, sloping edges, lipodermatosclerosis, and haemosiderin deposition (from red blood cell extravasation) — is classic for a venous leg ulcer due to chronic venous hypertension. Management begins with confirming adequate arterial supply (ABPI >0.8 allows full compression); four-layer compression bandaging is the gold standard treatment. Arterial ulcers are typically punched-out, painful, and occur at pressure points on digits and heels.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.