各种溃疡的鉴别诊断

,How to Distinguish Arterial, Venous and Other Ulcers,Zhijie Xi, MD,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,WOUND TYPES,ARTERIAL (ISCHEMIC) ULCERSVENOUS (VARICOSE, LEG,STASIS) ULCERSLYMPHEDEMA (CHRONIC DERMAL DISRUPTION) ULCERSPRESSURE (DECUBITUS) ULCERSLATE EFFECT OF TRAUMAUNCONTROLLED INFECTIONAUTOIMMUNE ULCERS (PSORIASIS,LUPUS, ETC),ELEMENTS COMMON TO MOST WOUNDS,VASCULAR COMPROMISE (ARTERIAL, VENOUS, MICROVASCULAR)REDUCED TISSUE OXYGEN CONCENTRATION (TCpO2)METABOLIC COMPROMISE,ARTERIAL ULCERS,Arterial Ulcers,ARTERIAL ULCERS,Usually have a “punched out” appearanceFull thickness defectMost often occurs in diabeticsMay be the result of embolic “showering” into the toesCan occur anywhere on the extremities,VENOUS ULCERS,Venous Ulcers,VENOUS ULCERS,Most often accompany varicose veinsMost often affect distal leg and ankleAre usually painful and heavily exudativeAre often recurrentExhibit varying depths, even within the same ulcerCan become huge,LYMPHEDEMA ULCERS,LYMPHEDEMA ULCERS,Are invariably foul and dirtySurrounding skin is induratedAre heavily exudativeCan expand to encompass the entire lower leg and top of the footAre usually infected with multiple organisms and yeastsOccur most often in association with obesity,PRESSURE ULCERS,PRESSURE ULCERS,Can occur anywhere following sustained pressureCan become life threateningAre often extremely foul and infected,AUTOIMMUNE ULCERS,AUTOIMMUNE ULCERS,Can mimic other ulcer typesAre often complicated with arterial/venous insufficienciesAre common with severe lupus, psoriasis and pemphigoid syndromesAre frequently recurrent,ULCERS OF MIXED ETIOLOGY,DIABETIC PLANTAR ULCER,BKA PRESSURE ULCER,DIABETIC/ARTERIAL ULCER,VENOUS/ARTERIAL ULCER,ULCERS OF MIXED ETIOLOGY,PRESSURE/VENOUS ULCER,VENOUS/ARTERIAL ULCER,PRESSURE/VENOUS/ARTERIAL,DIABETIC/PRESSURE ULCER,CONCLUSIONS,Single-etiology ulcers are uncommonWe should suspect arterial involvement in any ulcer that is accompanied by diabetesVenous leg ulcers often have a pressure component an