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INTRODUCTION TO CHAPTER

An understanding of the pathophysiology, diagnosis, and management of leg ulcers is very important to healthcare providers as these occur in a significant number of patients. Approximately 1–3% of the population, or up to 10 million people in the United States are affected.1 The annual cost of leg ulcers is proposed to be $8–10 billion per year, with an estimated loss of 2 million workdays per year.2 The majority of leg ulcers are seen in middle-aged to elderly patients, and there is a female:male predilection of 2:1. The three most common types of leg ulcers are venous, arterial, and neuropathic, although leg ulcers can also be multifactorial in origin. Defining the underlying etiology is of the utmost importance to designing a successful treatment plan.

VENOUS ULCERS

Introduction

Key Points for Venous Ulcers

  • ✓ Venous ulcers are caused by venous insufficiency and account for 70–80% of all leg ulcers.

  • ✓ They present as well-marginated ulcers with sloped borders on the lower leg usually over or proximal to the medial malleolus. Stasis dermatitis and varicosities are often seen in conjunction with these ulcers.

  • ✓ Pedal pulses are usually present.

  • ✓ The use of inelastic or elastic compression products is the gold standard for the treatment of venous leg ulcers.

Ulcers caused by venous insufficiency, are the most common type of leg ulcerations, accounting for 70–80%. They are often called stasis ulcers. 10–20% of leg ulcerations have a mixed venous and arterial etiology. Leg ulcers caused by chronic venous insufficiency lead to significant morbidity and can have a long-term negative impact on an individual's quality of life. The ability of affected patients to work, be active, and function well in society can be greatly compromised. Diagnosis can be challenging, and management is often expensive and labor-intensive for both the patient and the healthcare provider.

Pathogenesis

Venous ulcers most commonly arise secondary to varicose veins or postphlebitic syndrome. They may also be seen in patients with a history of a deep vein thrombosis (DVT), obesity, or previous leg injury or surgery. When a patient with normal venous return stands or walks, the calf muscle acts in concert with veins and associated valves to empty the venous system and reduce its pressure.3 When the valves become incompetent secondary to some form of injury, blood pools in the lower extremities and venous hypertension develops. This leads to tissue hypoxia and ultimately to skin destruction and breakdown. In addition, wound healing processes are compromised, and autolytic processes take action. The result is loss of the epidermis and dermis and the formation of an ulcer.

Clinical Presentation

History

Patients with venous insufficiency usually complain of a heavy or swollen feeling in the affected leg(s). ...

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