๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Introduction
Ariela Hafner and Eli Sprecher Ulcers
Chapter Contents
Synonyms:๏ก Ulcer โ wound, sore ๏ก Venous ulcer โ ulcer due to venous insufficiency/venous hypertension ๏ก Arterial ulcer โ ulcer due to atherosclerosis ๏ก Neuropathic ulcer โ mal perforans ๏ก Livedoid vasculopathyย โ atrophie blanche, livedoid vasculitis ๏ก Pressure ulcer โ decubitus ulcer, pressure sore, bed sore
Key features
ยThe history should include onset, course, symptoms, exacerbating and alleviating factors, past medical history, family history, social history, travel, and medications
ยImportant aspects of the physical examination include location, size, shape and depth of the ulcer, characteristics of the ulcer edge and base, and associated physical findings
ยHelpful laboratory evaluation includes vascular studies, blood tests
(e.g. for thrombophilia), microbial cultures, and biopsy
ยA biopsy of non-healing chronic ulcers is indicated to exclude carcinoma or other underlying diseases
ยIn addition to local care, therapy of ulcers should aim to correct or treat the underlying cause:
Venous insufficiency: compression
Arterial insufficiency: revascularization
Neuropathic or pressure ulcer: relief of pressure or other local factor that might be causing or exacerbating the ulceration
Infection: antibiotics
Neoplasm: surgery, chemotherapy, radiotherapy
Vasculopathy: treat the underlying cause of the occlusive disorder
Vasculitis or other inflammatory process (e.g. pyoderma gangrenosum): corticosteroids, immunosuppressive agents
ย A key factor in therapy is the promotion of wound healing:
Debridement: mechanical, enzymatic, autolytic
Dressings: maintain a moist wound environment
Infection control: antibiotics
Skin grafting or skin substitutes
Growth factors