脚溃疡的处理.pptVIP

Management of leg ulcers  Head note 400,000 patients with leg ulcer disease in the UK and 100,000 have open leg ulcers requiring treatment. Costs about 600 million/year. etiology, pathogenesis, treatment, and the future trends in the management of the leg ulcers are reviewed. Epidemiology INCIDENCE 0.2% in the UK PREVALENCE 0.15% to 0.18% in the UK 1% in the Scandinavian countries. Commonly in elderly people Etiology Etiology Pathogenesis of venous leg ulcers Excessive proteolytic activity by proteases, especially matrix metalloproteinases (MMPI, MMP2, MMP8, and MMP9) Venous stagnation incompetence of the valves high venous pressure Pathogenesis of venous leg ulcers Fibrin cuff injury and repair process coagulation process fibrinolysis process White cell trapping in venous hypertension, white cells are activated leading to damage and destruction of the capillaries Growth factor trapping inadequate tissue repair Mechanism of skin breakdown damage to blood vessels leading to ischemia inflammation infiltration Pathogenesis of arterial (ischaemic) ulceration  (1) Extramural strangulation scar tissue and radiodermatitis causing fibrotic bands around the arterioles (2) Mural thickening or accretion (plaques) atherosclerosis (3) Intramural restriction of blood flow blood viscosity, platelet adhesiveness and fibrinogenesis Diabetic foot ulcer Vessel disease : tissue hypoxia atherosclerosis microangiopathy peripheral gangrene Neuropathy with cold, swollen, and dry feet Trauma or blister lead to ulceration Haematological disorders Sickle cell disease : thalassaemia, and haemolytic anaemias blockage of microcirculation. Thrombotic and occlusive diseases : antiphospholipid syndrome, protein C and protein S deficiency, cryoglobulinaemia rapid skin necrosis and gangrene. Genetic disorders of coagulation : antithrombin III, fibrinogen, and factor V genes recurrent familial venous thrombosis . Infections Associated edema, cell