In healthy individuals, the lower limbs should be symmetrically warm, suggesting adequate perfusion.Place the dorsal aspect of your hand onto the patient’s lower limbs to assess and compare temperature: Venous guttering: veins that have very little blood within them due to poor blood supply to the limb, hence the “guttered” appearance.Foot calluses: often caused by an abnormal gait and/or poorly fitting footwear.Hair loss: occurs due to chronic impairment of tissue perfusion in PVD.Scars: may indicate previous surgical procedures (e.g.Missing limbs, toes, fingers: due to amputation secondary to critical ischaemia.red, black) and breakdown of the associated tissue. Typical appearances include a change in skin colour (e.g. Gangrene: tissue necrosis secondary to inadequate perfusion.These ulcers most commonly develop in the most peripheral regions of a limb (e.g. Arterial ulcers: typically small, well-defined, deep ulcers that are very painful.These ulcers most commonly develop over the medial aspect of the ankle. Venous ulcers: typically large and shallow ulcers with irregular borders that are only mildly painful.Peripheral pallor: a pale colour of the skin that can indicate poor perfusion.may be present in PVD due to poor perfusion). Peripheral cyanosis: bluish discolouration of the skin associated with low SpO 2 in the affected tissues (e.g.Inspect the lower limbs for relevant pathology, making sure to look at the posterior aspect of each leg and between each of the toes for hidden ulcers: You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.
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