Chronic Ulcers of the Leg of Venous Origin

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IT is estimated that 600,000 ulcers of the leg are treated annually in the United States — an estimated that is extrapolated from a reported incidence 15,000 ulcers of the leg treated annually in Denmark.1 These vast numbers argue a problem, the magnitude of which never has been evaluated in terms of physical disability and economic loss both to the individual and to the community. This study will present the current beliefs and practices in regard to the origin and treatment of the disease.

Classification of ulcers of the lower extremities. On the basis of etiology, six categories of ulcers of the lower extremities are recognized, as follows2:

  1. Arterial

    1. Organic origin

      1. Arteriosclerosis obliterans with or without diabetes

      2. Thromboangiitis obliterans

      3. Embolic or thrombotic occlusion

      4. Local pressure

    2. Spastic origin

      1. Raynaud’s disease

      2. Scleroderma

      3. Frostbite

      4. Local arteriospasm, traumatic or occupational

  2. Venous

    1. Varicose ulcers

    2. Phlebitis

    3. Congenital anomalies

  3. Specific ulcers

    1. Syphilis

    2. Tuberculosis

    3. Mycosis

    4. Drugs

    5. Vitamin deficiency

    6. Neurotrophic ulcers

    7. Infection

    8. Gout

    9. Regional enteritis

    10. Chronic ulcerative colitis

  4. Posttraumatic ulcers

    1. Occupational

    2. Factitial

  5. Blood dyscrasia

    1. Polycythemia

    2. Pernicious anemia

    3. Leukemia

    4. Sicklemia

  6. Malignant ulcers

This study is concerned chiefly with chronic ulcers in the second category: ulcers of the leg of venous origin.

Anatomy and pathogenesis. An understanding of the fundamental anatomy and pathologic physiology is the basis of rational therapy. The venous anatomy of the lower extremity . . .



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