Protein C and Protein S Plasma Levels in Patients With Lipodermatosclerosis and Venous Ulceration

Abstract

In Reply. \p=m-\We agree with the authors that when eschar is present d\l=e'\bridementis often necessary to determine the extent of the ulceration and that palpation may assist as well.Our classification of red areas' reflects our clinical practice of intervening if hyperemia persists for greater than 30 minutes.2 It is not necessary to wait for greater than 24 hours to institute therapeutic measures. Our approach is, in fact, more conservative than the authors outline. Of course, if their method has proven successful in their institutions, it can be used as long as there is sufficient interrater reliability. Muscle is frequently observed at the base of pressure ulcers. These ulcerations may occur in both common and uncommon areas and a classification including muscle is needed to classify all possible lesions. Patients who have had musculocutaneous flaps will certainly have muscle exposed if pressure ulcerations reoccur. We find grade IV to be useful and would not eliminate it from the classification.

Lipodermatosclerosis

“…(37) showed that 20% of the patients with LDS and venous ulcers have low protein S and C, findings supported by Samlaska et al. (57). As suggested by Leu et al.…”