1. A patient with adult-onset diabetes has an ulcer on the plantar surface of the foot. for a patient with adult-onset diabetes and an ulcer near the ankle? …
|Leg Ulcers |
William H Eaglstein, MD
The most common lower extremity ulcers are the venous ulcer, the diabetic
ulcer and the arterial ulcer Approximately 70 of leg ulcers are venous,
occurring mostly in the ankle area They are usually secondary to damaged
valves in the veins, which results in an inability of the venous pressure
to fall as is normal when walking This failure of the pressure to fall is
called sustained venous hypertension Diabetic ulcers occur almost
exclusively on the foot They are either secondary to large vessel
atherosclerosis or to diabetic neuropathy and loss of feeling The
neuropathic diabetic ulcers occur on pressure areas of the foot and toes
and can be thought of as pressure ulcers, while the atherosclerotic type
can be considered ischemic ulcers Arterial ulcers are secondary to large
vessel atherosclerosis Some leg ulcers are thought to be caused by
concomitant arterial and venous disease and are called mixed
Venous ulcers require compression wraps and, once healed, compression hose
There are many adjunctive therapies such as topical antimicrobials,
occlusive dressings, skin grafting and tissue
engineered skin Both
diabetic ischemic and arterial ulcers are treated with surgery to restore
arterial blood flow For diabetic neuropathic foot ulcers, the pressure
must be relieved off-loaded by special shoes, casts or crutches
References
1 Kirsner RS, Eaglstein WH, Kerdel FA Split-thickness skin grafting for
lower extremity ulcerations Dermatol Surg 1997; 23:85-91
2 Eaglstein WH, Falanga V Chronic wounds Surg Clin North Am 1997; 77:
689-700
3 Eaglstein WH Occlusive dressings J Dermatol Surg Oncol 1993; 19:716-
20
4 Falanga V, Eaglstein WH A therapeutic approach to venous ulcers J Am
Acad Dermatol 1986; 14:777-84
Figure Legends
Figure 1 Venous ulcer on the lateral malleolus within a background of post
inflammatory fibrosis
Figure 2 Neuropathic ulcer at a pressure point on the plantar surface of
the foot in a patient with diabetic neuropathy Note peripheral keratotic
rim
Figure 3 Arterial ulcer on the lateral surface of the foot in a patient
with severe arteriosclerosis
Questions - Leg Ulcers
1 A patient with adult-onset diabetes
has an ulcer on the plantar surface
of the foot The most likely diagnosis is which of the following?
A Venous hypertension
B Atherosclerosis of small vessels
C Peripheral neuropathy
D Bacterial infection
E Pyoderma gangrenosum
2 Which of the following is the most common leg ulcer?
A Diabetic
B Pyoderma gangrenosum
C Arterial ulcer
D Venous ulcer
E Mixed arterial/venous
3 Which of the following is the basic therapy for a patient with adult-
onset diabetes and an ulcer near the ankle?
A Compression wraps or hose
B Topical or oral antibiotics
C Skin grafting
D Surgical restoration of blood flow
E Intralesional corticosteroid injections
|Answers - Leg Ulcers |
1 A patient with adult-onset diabetes has an ulcer on the plantar surface
of the foot The most likely diagnosis is which of the following?
A Venous hypertension
B Atherosclerosis of small vessels
C Peripheral neuropathy
D Bacterial infection
E Pyoderma gangrenosum
Answer: C Peripheral
neuropathy
2 Which of the following is the most common leg ulcer?
A Diabetic
B Pyoderma gangrenosum
C Arterial ulcer
D Venous ulcer
E Mixed arterial/venous
Answer: D Venous ulcer
3 Which of the following is the basic therapy for a patient with adult-
onset diabetes and an ulcer near the ankle?
A Compression wraps or hose
B Topical or oral antibiotics
C Skin grafting
D Surgical restoration of blood flow
E Intralesional corticosteroid injections
Answer: D Surgical restoration of blood flow
Source:sjsu.edu
