Dissemond J, Bültemann A, Gerber V, Motzkus M, Rembe J-D, Erfurt-Berge C
Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
Dermatologie (Heidelb). 2023 Jul;74(7):555-559. doi: 10.1007/s00105-023-05129-2. Epub 2023 Mar 14.
A wound on the lower legs of patients with chronic venous insufficiency (CVI) and peripheral arterial disease (PAD) is today usually referred to as a mixed leg ulcer. This does not take into account the different stages of the diseases and, thus, their pathophysiological relevance. In everyday clinical practice, this often leads, among other things, to these patients not receiving compression therapy. The multidisciplinary professional association Initiative Chronische Wunden (ICW) e. V., therefore, recommends that this undifferentiated and misleading term should no longer be used. Instead, a leg ulcer with advanced CVI and concomitant PAD in stage I-IIb according to Fontaine or Rutherford category 0-3 should be classified as a venous leg ulcer, while a leg ulcer with advanced PAD in stage III or IV according to Fontaine or Rutherford category 4-6 and advanced CVI is termed an arteriovenous leg ulcer. A leg ulcer in advanced PAD stage IV according to Fontaine or Rutherford category 5 or 6 without advanced CVI is called an arterial leg ulcer. Other relevant comorbidities with an influence on wound healing should also be described separately.
慢性静脉功能不全(CVI)和外周动脉疾病(PAD)患者小腿上的伤口如今通常被称为混合性腿部溃疡。这并未考虑到疾病的不同阶段以及它们的病理生理相关性。在日常临床实践中,这常常导致这些患者无法接受压迫疗法等情况。因此,多学科专业协会慢性伤口倡议组织(ICW)建议不再使用这个未区分且具有误导性的术语。相反,根据Fontaine或Rutherford分类为0 - 3期的I - IIb期晚期CVI合并PAD的腿部溃疡应归类为静脉性腿部溃疡,而根据Fontaine或Rutherford分类为4 - 6期的III或IV期晚期PAD合并晚期CVI的腿部溃疡则称为动静脉性腿部溃疡。根据Fontaine或Rutherford分类为5或6期的IV期晚期PAD且无晚期CVI的腿部溃疡称为动脉性腿部溃疡。其他对伤口愈合有影响的相关合并症也应分别描述。