Ulcers of the lower extremities (CIS) are very common. They are divided into two groups: ulcers of the leg and foot ulcers, due to the differences in the causes, pathogenesis, and treatment. Around 70% of leg ulcers are caused by venous disease, and about 20% are due to arterial insufficiency or disease arteriovenous mixed. Approximately 85% of foot ulcers are caused by a peripheral neuropathy, often complicated by arterial disease.Risk factors for venous ulcers of the leg are: advanced age, female sex, family history of venous leg ulcer, white race, history of deep venous thrombosis or phlebitis, previous injury in the leg, edema, chronic leg, sedentary lifestyles, and standing for a long time.The risk factors for any ulcer blood are: diabetes mellitus, hypertension, hyperlipidemia, obesity, and smoking. Risk factors for foot ulcers include the lack of sensitivity, the limitation of joint mobility, anatomical abnormalities, diabetes mellitus, vascular disease, and increased repetitive of the local pressure.Pathophysiological characteristics of the types of ulcer
♦ Venous leg ulcers: When the valves in the veins of the legs are damaged or veins are dilated occurs the blood flow retrograde and hypertension. The end result is an open wound, draining, with overlay of esfacelo and induration surrounding.
♦ Ulcers arterial: Arterial ulcers are the result of tissue perfusion altered. In addition to the restriction intramural blood flow, the strangling outreach and the thickening of the mural also contribute to reducing the perfusion. The causes of arterial blood flow is reduced are the atherosclerotic peripheral vascular disease, the disease micro-and macro-vascular due to diabetes mellitus, vasculitis, and microthrombos. The lowest perfusion of the skin and soft tissues, causing ischemia and necrosis subsequent leading to ulceration of the leg. Recurrent episodes of ischemia and reperfusion further damage tissues.
♦ Diabetic ulcers: The causes of diabetic foot ulcers are multifactorial and include arterial insufficiency and neuropathy, which confer a predisposition to injury and to the formation of ulcers. The loss of protective sensation in patients with diabetes makes them vulnerable to physical trauma, and therefore, in patients with diabetes should be done a meticulous care of the feet and a frequent inspection of your feet. The deficiency of sweating and impaired perfusion of the foot cause dry skin which makes the skin lesions following a minimal trauma repetitive. Autonomic neuropathy leads to foot deformities (e.g., Charcot foot) resulting from the pressure on areas of prominent standing. Other abnormalities associated with diabetes mellitus (such as the defective function of the leukocytes) are detrimental to the healing of wounds and leads to the perpetuation of the ulcers, and secondary infection.
♦ Pressure sores: Pressure ulcers are caused by constant pressure on bony prominences such as the heel, and usually develop in patients not on an outpatient basis. Prolonged compression of the tissues along with the friction and the shear produce tissue ischemia and local necrosis, which leads to the formation of ulcers.Most types of ulcers can be identified on according to its appearance and location. You should do a story focused on coexisting medical conditions, such as diabetes mellitus, peripheral arterial disease, and deep venous thrombosis, which may give a clue to the underlying cause of the ulcer. In addition to an examination of the wound and the surrounding skin, the physical examination should include an assessment neurovascular aimed to identify the neuropathy and arterial insufficiency.
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