The Evaluation of Lower-Extremity Ulcers

Abstract

Lower-limb ulceration is prevalent in Western countries. There are many different types of ulcers with several causes. The most prevalent are those due to vascular disease, of which venous is the most common, accounting for over two-thirds of all types of ulcers. There are also many other causes for ulceration such as malignancy, infections, and skin, drug-induced, and autoimmune diseases. The ulcers have different characteristics, which may be differentiated by the history and clinical examination of the patients. However, objective documentation for the ulcer etiology is necessary prior to instigating treatment. The methods for diagnosing the causes for the ulcers include plethysmography, ultrasound, angiography, computer tomography, magnetic resonance imaging, and skin biopsy. All these tests should be used in conjunction with the clinical presentation of the patient. They should be performed in a cost-effective manner to avoid delays in diagnosis and reduce costs and usage of resources.

Subsiding of Dependent Oedema Following Chiropractic Adjustment for Discogenic Sciatica

“…Patients requiring prolonged bed rest develop oedema in the buttocks, genitals and posterior thighs. Venous stasis eventually leads to venous hypertension, dilation of the small veins and dermal capillaries, and inflammatory events in the inner lining of the veins (Spentzouris & Labropoulos 2009). The deoxgenated venous blood stagnated in the cutaneous microcirculation can lend a bluish or purplish tinge to the skin and permit fluid shifting into the interstitial compartment, as illustrated in this patient (Figure 2).…”

Amputation-free limb survival in diabetic foot lesions: A Review

“…The factors considered to influencing blood quantity were absence of pedal pulses and ankle brachial index of less than 0.9 or ankle peak systolic velocity of <75 cm/s [7][8][9] . Associated comorbidities taken into consideration included both systemic and regional conditions likely to impair wound healing or impede interventional measures, as follows: systemic diseases, such as heart failure (congestive or ischemic); chronic renal failure; and autoimmune collagen likely to cause vasculitis such as rheumatoid arthritis, systemic lupus, scleroderma, and non-specific arteritis [10][11][12][13][14] . The regional diseases that were considered in this category were conditions involving the limbs such as chronic lymphedema and chronic venous insufficiency.…”

Evidence‐based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans

“…A recent study by Olsen et al 6 assessed the impact of EB ulcer care on healing of venous ulcers which account for over 70% of all LLUs 7 . They reported the likelihood of venous ulcer healing among Veterans increased when compression therapy, sharp debridement, and moist wound healing were all provided in at least 80% of visits (RR= 2.52; 95% confidence interval [CI]: 1.53-4.16).…”

“…Compression therapy and moist wound healing both independently increased the likelihood of healing when performed at ≥ 80% of visits, however debridement alone was not significantly associated with venous ulcer healing. 6 Arterial insufficiency, the second most common cause of LLUs, comprises 10-30% of all chronic LLUs 7 . Diabetic LLUs comprise 15-25% of ulcers 7 and have the worst prognosis and the highest amputation rate.…”

“…6 Arterial insufficiency, the second most common cause of LLUs, comprises 10-30% of all chronic LLUs 7 . Diabetic LLUs comprise 15-25% of ulcers 7 and have the worst prognosis and the highest amputation rate. 5,8 Since the prevalence of diabetes is higher among Veterans (24%) compared to the general population (8%), they experience higher rates of diabetes-related ulcers and amputations making this a priority clinical problem.…”