1. General considerations
2. History
3. Inspection
4. Palpation

General considerations

• Definition of ulcer: a break in epithelial surface, extending to all layers of epithelium.
• Types: VANITy:
  • Venous: deep or superficial insufficiency.
  • Arterial: large or small vessel dz.
  • Neoplastic: 1º or 2º
  • Infective
  • Traumatic 

History

• When arose.
• Change in size, appearance, etc.
• Whether previous ulcers.
• Painful vs. painless.
• PMH: varicose veins, DM, DVT, trauma, intermittent claudication, vascular dz, infections, CA.
• SH: smoking, occupation invloving standing up for long periods.
• How often wound is being dressed.

Inspection

• Size, shape, site, fluid discharges. 
• Depth.
• Base: 
  • Color.
  • Granulation tissue.
  • Tissues exposed: ligaments, bone, etc..
• Slope/edge:
  • Slope outwards (TB).
  • Slope inwards/ "undermined" (venous).
  • Vertical edge/ "punched-out" (non-healing).
  • Raised
  • Raised and everted

Palpation

• Local pulses
• Lymph nodes, tenderness, temperature.