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Arterial ulcers -  'punched-out' appearance.

typically seen above medial malleolus

''Investigations''
 ankle-brachial pressure index (ABPI) to assess arterial flow (cause of poor ulcer healing) - normal 0.9-1.2
 <0.9 - arterial disease
 <1.3 arterial disease (false negative secondary to arterial calcification (eg diabetics)

''Management''
    compression bandaging, usually four layer (only treatment shown to be of real benefit)
    oral pentoxifylline, a peripheral vasodilator, improves healing rate
    small evidence base supporting use of flavinoids
    little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression