各种溃疡的鉴别诊断课件.pptxVIP

How to Distinguish Arterial, Venous and Other UlcersZhijie Xi, MDGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineWOUND TYPES?ARTERIAL (ISCHEMIC) ULCERS?VENOUS (VARICOSE, LEG,STASIS) ULCERS?LYMPHEDEMA (CHRONIC DERMAL DISRUPTION) ULCERS?PRESSURE (DECUBITUS) ULCERS?LATE EFFECT OF TRAUMA?UNCONTROLLED INFECTION?AUTOIMMUNE ULCERS (PSORIASIS,LUPUS, ETC)ELEMENTS COMMON TO MOST WOUNDSVASCULAR COMPROMISE (ARTERIAL, VENOUS, MICROVASCULAR)?REDUCED TISSUE OXYGEN CONCENTRATION (TCpO2)?METABOLIC COMPROMISEARTERIAL ULCERSArterial UlcersARTERIAL ULCERS?Usually have a “punched out” appearance?Full thickness defect?Most often occurs in diabetics?May be the result of embolic “showering” into the toes?Can occur anywhere on the extremitiesVENOUS ULCERSVenous UlcersVENOUS ULCERS?Most often accompany varicose veins?Most often affect distal leg and ankle?Are usually painful and heavily exudative?Are often recurrent?Exhibit varying depths, even within the same ulcer?Can become hugeLYMPHEDEMA ULCERSLYMPHEDEMA ULCERS ?Are invariably foul and dirty?Surrounding skin is indurated?Are heavily exudative?Can expand to encompass the entire lower leg and top of the foot?Are usually infected with multiple organisms and yeasts?Occur most often in association with obesityPRESSURE ULCERSPRESSURE ULCERS?Can occur anywhere following sustained pressure?Can become life threatening?Are often extremely foul and infectedAUTOIMMUNE ULCERSAUTOIMMUNE ULCERS?Can mimic other ulcer types?Are often complicated with arterial/venous insufficiencies?Are common with severe lupus, psoriasis and pemphigoid syndromes?Are frequently recurrentULCERS OF MIXED ETIOLOGYDIABETIC PLANTAR ULCERBKA PRESSURE ULCERDIABETIC/ARTERIAL ULCERVENOUS/ARTERIAL ULCERULCERS OF MIXED ETIOLOGYPRESSURE/VENOUS ULCERVENOUS/ARTERIAL ULCERDIABETIC/PRESSURE ULCERPRESSURE/VENOUS/ARTERIALCONCLUSIONS?Single-etiology ulcers are uncommon?We should suspect arterial involvement in any ulcer that is accompanied by diabetes?Ven