1、各种溃疡的鉴别诊断各种溃疡的鉴别诊断WOUND TYPESARTERIAL(ISCHEMIC)ULCERSVENOUS(VARICOSE,LEG,STASIS)ULCERSLYMPHEDEMA(CHRONIC DERMAL DISRUPTION)ULCERSPRESSURE(DECUBITUS)ULCERSLATE EFFECT OF TRAUMAUNCONTROLLED INFECTIONAUTOIMMUNE ULCERS(PSORIASIS,LUPUS,ETC)2ELEMENTS COMMON TO MOST WOUNDS VASCULAR COMPROMISE(ARTERIAL,VENO
2、US,MICROVASCULAR)REDUCED TISSUE OXYGEN CONCENTRATION(TCpO2)METABOLIC COMPROMISE3ARTERIAL ULCERS4Arterial Ulcers5ARTERIAL ULCERSUsually have a“punched out”appearanceFull thickness defectMost often occurs in diabeticsMay be the result of embolic“showering”into the toesCan occur anywhere on the extremi
3、ties6VENOUS ULCERS7Venous Ulcers8VENOUS ULCERSMost 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 huge9LYMPHEDEMA ULCERS10LYMPHEDEMA ULCERS Are invariably foul
4、 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 obesity11PRESSURE ULCERS12PRESSURE ULCERS Can occur anywhere following sustained pre
5、ssure Can become life threatening Are often extremely foul and infected13AUTOIMMUNE ULCERS14AUTOIMMUNE ULCERSCan mimic other ulcer typesAre often complicated with arterial/venous insufficienciesAre common with severe lupus,psoriasis and pemphigoid syndromesAre frequently recurrent15ULCERS OF MIXED E
6、TIOLOGYDIABETIC PLANTAR ULCERBKA PRESSURE ULCERDIABETIC/ARTERIAL ULCERVENOUS/ARTERIAL ULCER16ULCERS OF MIXED ETIOLOGYPRESSURE/VENOUS ULCERVENOUS/ARTERIAL ULCERPRESSURE/VENOUS/ARTERIALDIABETIC/PRESSURE ULCER17CONCLUSIONSSingle-etiology ulcers are uncommonWe should suspect arterial involvement in any ulcer that is accompanied by diabetesVenous leg ulcers often have a pressure component and,in diabetics,an arterial compromiseAny ulcer may be compromised in the presence of autoimmune diseases18
