Chronic ulceration
Classification
Vascular                           
Arterial:Atherosclerosis,Buerger’s Disease,Vasculitis,Raynaud’s Disease
Venous:Chronic venous insufficiency,Varicose Veins,Post Sclerotherapy               
Lymphatic:Chronic Lymphodema   

Infective:Pyogenic,Osteomyelitis,Synergistic Gangrene,Syphilis,Tuberculosis,Tropical Diseases,Fungal Diseases
Neoplastic:Melanoma,Kaposi’s Sarcoma
Systemic-Metabolic:Ulcerative Colitis,Diabetes,Sickle Cell Disease,Avitaminosis
Neurotrophic:Cord Lesions,Peripheral Neuropathies,Trauma,Diabetes,Tabes dorsalis,Alcoholism

The history of an ulcer
Arterial
Chronic ischaemic symptoms
 Claudication/rest pain
Risks-Hypertension, smoking, cholesterol, diabetes, exercise
Previous arterial interventions

Vasculitis
History of autoimmune disease
Painful
Lack chronic arterial occlusive symptoms
Systemic symptoms of autoimmune disease

Neoplastic
Chronicity
Previous malignancy
Risks
 Exposures
 UV radiation
 Ionising radiation

The Examination of an Ulcer
Arterial           
 Atrophic Skin & Nails                      
 Poor capillary return                       
 Beurger’s angle                           
 Absent pulses, thrills, bruits

Venous           
 pigmentation                           
 eczema                               
 lipodermatosclerosis                       
 varicose veins                                   

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