arterial ulcer
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Etiology
Clinical manifestations
- atrophic skin bordering ulcer
- pallor on elevation of extremity
- diminished pulses, cool skin
- relatively painful lesions
- pain may worsen at night
- pain may worsen with elevation of extremities
- pain may lessen with hanging the foot over the edge of the bed[4]
- punched-out necrotic ulcers with surrounding erythema[1]
- distribution
- pretibial areas
Diagnostic procedures
- diminished ankle/brachial index (< 0.5-0.6)
Differential diagnosis
- cholesterol embolization is suggested by infarction of the toes in association with livedo reticularis
- venous stasis ulcer (see[6] for comparison)
- occur most commonly near the medial malleolus
- associated with signs of chronic venous insufficiency
- often weep serous fluid
- neuropathic ulcer
- secondary to repetitive trauma to the skin, typically in patients with diabetic peripheral neuropathy with reduced awareness of pressure or trauma to the skin
- neuropathic ulcers in diabetics are painless, most common on the plantar surface of the feet, callus & foot deformity are common
Management
- avoid friction & pressure
- dressing
- foam dressing
- hydrogel
- alginate dressing
- absorptive wound filler
- collagen-based dressing
- gauze
- do NOT use hydrocolloid dressing
- do NOT moisten an arterial ulcer if no healing potential, leave dry
- do NOT debride ischemic arterial ulcer[2]
- risk factor management[1]
- measures to increase blood supply
- limited evidence of benefit for cilostazol[1]
- referral to vascular surgeon[1]
- revascularization may facilitate wound healing[1]
More general terms
Additional terms
- neuropathic ulcer
- peripheral arterial disease; peripheral artery atherosclerosis (PAD)
- pressure ulcer (decubitus ulcer, bedsore)
- venous stasis ulcer
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
- ↑ 2.0 2.1 2.2 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 4.0 4.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ 5.0 5.1 Gabriel A, Molnar JA (image) Medscape: Vascular Ulcers http://emedicine.medscape.com/article/1298345-overview
- ↑ 6.0 6.1 6.2 London Health Sciences Centre. (image) Venous Stasis & Arterial Ulcer Comparison. http://www.lhsc.on.ca/Health_Professionals/Wound_Care/venous.htm
- ↑ Grey JE, Harding KG, Enoch S. Venous and arterial leg ulcers. BMJ. 2006 Feb 11;332(7537):347-50 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16470058
- ↑ Rothaus C Evaluation and Management of Lower-Extremity Ulcers. NEJM Resident 360. Oct 19, 2017 https://resident360.nejm.org/content_items/evaluation-and-management-of-lower-extremity-ulcers