Rayala Brian Z
University of North Carolina School of Medicine Department of Family Medicine, 590 Manning Drive, Chapel Hill, NC 27599.
FP Essent. 2020 Dec;499:11-18.
Pressure, venous leg, and arterial ulcers are common and costly skin conditions that affect patients in all clinical settings. Clinical features can help differentiate these ulcers. Pressure ulcers are associated with restricted mobility, poor perfusion, and compromised skin status. Venous leg ulcers (VLUs) are attributed to chronic venous hypertension resulting from venous insufficiency or obstruction. Risk factors for a first VLU include previous nonvenous leg ulcer, male sex, chronic venous hypertension, and older age. Arterial ulcers result from skin and soft tissue ischemia due to arterio-occlusive disease. They are associated with hypertension, diabetes, chronic kidney disease, and smoking. Various methods of pressure offloading have strong evidence of effectiveness in prevention of pressure ulcers. Clinical practice guidelines support the use of compression therapy in patients with previous VLUs to prevent ulcer recurrence. For patients with chronic lower extremity ulcers, a crucial step in evaluation is measurement of the ankle-brachial index, which can identify decreased perfusion and indicate the need for referral to a vascular surgeon. The likelihood of bone involvement should be determined. Skin and soft tissue infections often complicate wound care and should be addressed at each patient evaluation. Various factors can predict likelihood of wound healing.
压力性溃疡、下肢静脉溃疡和动脉溃疡是常见且代价高昂的皮肤疾病，影响着所有临床环境中的患者。临床特征有助于区分这些溃疡。压力性溃疡与活动受限、灌注不良和皮肤状况受损有关。下肢静脉溃疡（VLU）归因于静脉功能不全或阻塞导致的慢性静脉高压。首次发生VLU的危险因素包括既往非静脉性腿部溃疡、男性、慢性静脉高压和高龄。动脉溃疡是由动脉闭塞性疾病导致的皮肤和软组织缺血引起的。它们与高血压、糖尿病、慢性肾病和吸烟有关。各种减压方法在预防压力性溃疡方面有强有力的有效性证据。临床实践指南支持对既往有VLU的患者使用压迫疗法以预防溃疡复发。对于慢性下肢溃疡患者，评估的关键步骤是测量踝肱指数，这可以识别灌注降低并表明需要转诊给血管外科医生。应确定骨受累的可能性。皮肤和软组织感染常常使伤口护理复杂化，应在每次患者评估时加以处理。多种因素可以预测伤口愈合的可能性。
