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Australian Family Physician Mar 2014Necrobiosis lipoidica presents with a distinctive appearance making it an important clinical diagnosis.
BACKGROUND
Necrobiosis lipoidica presents with a distinctive appearance making it an important clinical diagnosis.
OBJECTIVE
To describe a case of necrobiosis lipoidica in a patient with type 1 diabetes mellitus, and to discuss differential diagnoses and management.
DISCUSSION
Necrobiosis lipoidica is most commonly found on the shins, presenting as a well-defined plaque. Management is challenging and options are discussed. Avoiding ulceration is a key concern.
Topics: Adult; Diabetes Mellitus, Type 1; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Necrobiosis Lipoidica; Risk Factors; Tacrolimus
PubMed: 24600675
DOI: No ID Found -
Ugeskrift For Laeger Sep 2017
Topics: Aged; Humans; Leg Ulcer; Male; Pain; Skin Transplantation
PubMed: 28918780
DOI: No ID Found -
Australian Family Physician Jul 2006A leg ulcer is not a disease but the manifestation of an underlying problem that requires a clear diagnosis. (Review)
Review
BACKGROUND
A leg ulcer is not a disease but the manifestation of an underlying problem that requires a clear diagnosis.
OBJECTIVE
This article outlines the assessment and management of patients with leg ulceration.
DISCUSSION
The simple tag of 'leg ulcer' is not an adequate diagnosis. A comprehensive assessment of the patient, skin, vascular status, limb, and ulcer is required to determine the aetiology and to formulate an appropriate management plan. Most leg ulcers are caused by venous insufficiency and compression is required to successfully heal venous leg ulcers. Treatment must address oedema, infection and pressure. Managing peripheral oedema using compression bandages is often more important than the topical dressings. Success requires consistent adherence to a care plan designed to address the underlying pathology and contributing factors.
Topics: Family Practice; Humans; Leg Ulcer; Physical Examination; Stockings, Compression; Vascular Diseases; Wound Healing; Wound Infection
PubMed: 16820817
DOI: No ID Found -
Acta Dermato-venereologica May 2021Chronic ulcers cause a significant burden to patients and society. This study evaluated long-term mortality among patients with chronic ulcers diagnosed at a dermatology...
Chronic ulcers cause a significant burden to patients and society. This study evaluated long-term mortality among patients with chronic ulcers diagnosed at a dermatology clinic between 1980 and 2010. The mortality risk and causes of death of 3,489 patients with ulcers were compared with a matched reference group of 10,399 individuals, and factors associated with increased mortality risk were examined. Long-term mortality was increased in patients with chronic ulcers (hazard ratio (HR) 1.74) and in both males and females (HR 1.99 and 1.62, respectively). Diabetes was the most relevant underlying cause of death (HR 8.98), and of the immediate causes of death, sepsis was strongly associated with mortality (HR 5.86). The mortality risk was highest among those with arterial ulcers (HR 2.85), but also increased in patients with atypical, mixed and venous leg ulcers. In conclusion, patients with chronic ulcers are at an increased mortality risk irrespective of age, sex and ulcer aetiology.
Topics: Diabetes Mellitus; Female; Humans; Leg Ulcer; Male; Ulcer; Varicose Ulcer; Wound Healing
PubMed: 33856039
DOI: 10.2340/00015555-3803 -
Australian Family Physician Sep 2014Chronic leg ulcers caused by venous disease, arterial disease or a combination of both need to be clearly identified before treatment can be commenced. Their management...
BACKGROUND
Chronic leg ulcers caused by venous disease, arterial disease or a combination of both need to be clearly identified before treatment can be commenced. Their management will depend on the diagnosis, combining direct management of the ulcer as well as management of patient factors. Other chronic wounds commonly observed in practice include pressure wounds, skin tears, atypical leg ulcers.
OBJECTIVE
This paper will outline a simple way to manage people with chronic ulcers.
CONCLUSION
Conclusion The prevalence of chronic wounds is expected to rise given that people are living longer and that the incidence of diabetes is increasing. There is a need is to clearly identify the underlying cause of any wound, including factors that may delay healing, and to treat appropriately. Treatment should address the wound environment, tissue base, presence of bacteria and the level of slough. If there is no improvement in wound healing after 4 weeks then seek help from a wound specialist.
DISCUSSION
The prevalence of chronic ulcers in Australia has been estimated at 2-5%. Comprehensive assessment of the ulcer, the region and the whole person is an important first step in treatment. The aim of management is to promote healing and minimise the impact on the patient.
Topics: Australia; Bandages; Chronic Disease; Disease Management; Humans; Leg; Leg Ulcer; Pressure Ulcer; Prevalence; Recurrence; Wound Healing
PubMed: 25225641
DOI: No ID Found -
International Wound Journal Aug 2023Venous leg ulcers have multiple consequences for the patient. Ulcer management can be lengthy and recurrence is common. As the patient is the expert on their experiences...
Venous leg ulcers have multiple consequences for the patient. Ulcer management can be lengthy and recurrence is common. As the patient is the expert on their experiences and life, the aim of the present study was to describe patients' lived experiences of undergoing management for a venous leg ulcer. The study encompassed 16 phenomenological interviews. The analysis led to a description of the phenomenon's essence, further described by three constituents. The essential meaning of the phenomenon is described as being in an oscillation between hope and despair. Ulcer management is challenging for the patient, who feels unseen and lives with doubts during the management period. This study is considered enriching as it puts words to the patients' suffering during ulcer management and shows that reliable relationships and competence can reduce patient doubts. This knowledge should enable improvement of patient care and treatment during ulcer management.
Topics: Humans; Ulcer; Varicose Ulcer; Emotions; Leg Ulcer
PubMed: 36457152
DOI: 10.1111/iwj.14044 -
International Wound Journal Dec 2020A chronic leg ulcer is a debilitating illness, owing to the local condition of the wound and a decrease in physical activity and productivity, resulting in anxiety and...
A chronic leg ulcer is a debilitating illness, owing to the local condition of the wound and a decrease in physical activity and productivity, resulting in anxiety and depression among patients. The study aimed to find any association of anxiety and depression in the healing of chronic wounds. A total of 125 patients with chronic leg ulcers were enrolled in the study. HADS questionnaire assessment followed the local wound examination in all patients. A follow-up assessment of the ulcer was done after appropriate local treatment, and data analysed with the HADS scale. In the present study, the ROC curve showed a cutoff value of 14 for the HADS score in predicting ulcer status (non-healing vs healed) after 30 days. A total of 54.4% (68) patients had a HADS score ≥ 14 and 39% (49) were true positive for the non-healing wound at a 1-month follow-up. This study revealed a sensitivity and specificity of 83.1% and 71.2%, respectively (P-value <.001), and diagnostic accuracy of 76.8%, for HADS score > 14 in the detection of non-healing ulcers. Chronic leg ulcers should be subjected to HADS assessment and if found significant corrective measures must be instituted for improving wound healing.
Topics: Anxiety; Depression; Hospitals; Humans; Leg Ulcer; Prospective Studies; Varicose Ulcer; Wound Healing
PubMed: 32844523
DOI: 10.1111/iwj.13485 -
Soins; La Revue de Reference Infirmiere Sep 2017The measurement of the ankle-brachial pressure index is essential for the treatment of leg ulcers. In the framework of the imminent implementation of advanced practices... (Review)
Review
The measurement of the ankle-brachial pressure index is essential for the treatment of leg ulcers. In the framework of the imminent implementation of advanced practices in France, nurses specifically trained in wound care and healing could be authorised to take and interpret this measurement. Venous compression techniques could therefore be adapted more precisely to the needs of the patients.
Topics: Ankle Brachial Index; Humans; Leg Ulcer; Nurse's Role
PubMed: 28923443
DOI: 10.1016/j.soin.2017.06.008 -
International Wound Journal Dec 2008Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three... (Review)
Review
Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.
Topics: Aged; Chronic Disease; Community Health Nursing; Cost-Benefit Analysis; Dermatology; Electronic Mail; Female; Home Care Services; Hospitals, General; Humans; Leg Ulcer; Male; Mexico; Middle Aged; Photography; Remote Consultation; Skin Care; Transportation; Wound Healing
PubMed: 18808429
DOI: 10.1111/j.1742-481X.2008.00478.x -
International Wound Journal Dec 2021Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt... (Review)
Review
Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt identification of concomitant arterial occlusive disease is critical to determine underlying aetiology and subsequent management. This integrative review presents the current evidence to establish the role of modified compression therapy (MCT) in treatment of mixed arterial venous leg ulcers (MAVLU). A literature search was conducted using the electronic databases CINAHL, MEDLINE, PUBMED, and Embase. Ten studies met the eligibility criteria and were subsequently analysed. Our review concludes that MCT, with compression pressures between 20 and 30 mmHg, can promote healing in MAVLU with moderate arterial insufficiency (0.5 ≤ ABPI ≤0.8). If ABPI is <0.5, MCT can be considered once restoration of acceptable ABPI is achieved. Intolerance, lack of response or further deterioration of disease within 3 months should prompt further arterial imaging and intervention. MCT is generally well tolerated with no adverse outcomes reported. A holistic yet individualised approach is vital in order to account for all factors influencing this patient-led decision-making process, ultimately ensuring effective treatment, which improves patient's quality of life and reduces socioeconomic burden of the disease.
Topics: Compression Bandages; Humans; Leg Ulcer; Quality of Life; Varicose Ulcer; Veins; Wound Healing
PubMed: 33738975
DOI: 10.1111/iwj.13585