Mayrovitz Harvey N, Wong Summer, Mancuso Camilla
Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA.
Dermatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.
Cureus. 2023 Apr 25;15(4):e38123. doi: 10.7759/cureus.38123. eCollection 2023 Apr.
Leg ulcers are a common and often serious problem in older adults. Underlying conditions that increase risk include age-related increases in chronic venous insufficiency, peripheral artery disease, connective tissue and autoimmune conditions, reduced mobility, and diabetes mellitus (DM). Geriatric patients have a higher risk of multiple wound-related complications including infection, cellulitis, ischemia, and gangrene, any of which may lead to further complications including amputation. The very presence of these lower extremity ulcers in the elderly negatively impacts their quality of life and ability to function. Understanding and early identification of the underlying conditions and wound features are important for effective ulcer healing and complication mitigation. This targeted review focuses on the three most common types of lower extremity ulcers: venous, arterial, and neuropathic. The goal of this paper is to characterize and discuss the general and specific aspects of these lower extremity ulcers and their relevancy and impact on the geriatric population. The top five main results of this study can be summarized as follows. (1) Venous ulcers, caused by inflammatory processes secondary to venous reflux and hypertension, are the most common chronic leg ulcer in the geriatric population. (2) Arterial-ischemic ulcers are mainly due to lower extremity vascular disease, which itself tends to increase with increasing age setting the stage for an age-related increase in leg ulcers. (3) Persons with DM are at increased risk of developing foot ulcers mainly due to neuropathy and localized ischemia, both of which tend to increase with advancing age. (4) In geriatric patients with leg ulcers, it is important to rule out vasculitis or malignancy as causes. (5) Treatment is best made on a case-by-case basis, considering the patient's underlying condition, comorbidities, overall health status, and life expectancy.
腿部溃疡在老年人中是一个常见且往往较为严重的问题。增加风险的潜在因素包括与年龄相关的慢性静脉功能不全、外周动脉疾病、结缔组织和自身免疫性疾病的增加、活动能力下降以及糖尿病。老年患者发生多种与伤口相关并发症的风险更高，包括感染、蜂窝织炎、缺血和坏疽，其中任何一种都可能导致包括截肢在内的进一步并发症。老年人下肢溃疡的存在会对他们的生活质量和功能能力产生负面影响。了解并早期识别潜在病因和伤口特征对于有效促进溃疡愈合和减轻并发症至关重要。本针对性综述聚焦于下肢溃疡最常见的三种类型：静脉性、动脉性和神经性。本文的目的是描述和讨论这些下肢溃疡的一般和特定方面，以及它们与老年人群的相关性和影响。本研究的前五项主要结果可总结如下。（1）静脉性溃疡是老年人群中最常见的慢性腿部溃疡，由静脉反流和高血压继发的炎症过程引起。（2）动脉缺血性溃疡主要归因于下肢血管疾病，随着年龄增长，这种疾病本身往往会增加，为与年龄相关的腿部溃疡增加奠定了基础。（3）糖尿病患者发生足部溃疡的风险增加，主要是由于神经病变和局部缺血，这两者都往往随着年龄增长而增加。（4）在患有腿部溃疡的老年患者中，排除血管炎或恶性肿瘤作为病因很重要。（5）治疗最好根据具体情况进行，考虑患者的潜在病情、合并症、整体健康状况和预期寿命。
