[Leg ulcers (ulcus cruris): The frequent macrovascular causes]

Area of Science:

• Vascular Surgery
• Dermatology
• Wound Healing

Background:

• Leg ulcers (ulcus cruris) have diverse macrovascular etiologies.
• Venous, mixed venous-arterial, arterial, and Martorell hypertensive ischemic leg ulcers represent the primary macrovascular causes.
• Accurate diagnosis is essential for effective treatment.

Purpose of the Study:

• To outline the macrovascular causes of leg ulcers.
• To describe diagnostic and therapeutic approaches for different leg ulcer types.
• To highlight the importance of vascular work-up in all leg ulcer cases.

Main Methods:

• Review of macrovascular etiologies of leg ulcers.
• Description of diagnostic work-up including vascular assessment, microbiology, and biopsy.
• Overview of treatment modalities: compression therapy, surgical interventions (vein ablation, stenting, revascularization, grafting), shave therapy, fasciectomy, negative pressure wound treatment (NPWT), skin equivalents, and dermal matrices.

Main Results:

• Venous leg ulcers (50%) are primarily treated with compression therapy and venous interventions.
• Mixed venous-arterial leg ulcers (20%) require adjusted compression and often arterial revascularization.
• Arterial leg ulcers (5%) and Martorell hypertensive ischemic leg ulcers (5%) necessitate arterial revascularization and grafting, with specific considerations for the latter's underdiagnosis.

Conclusions:

• Effective management of leg ulcers hinges on precise etiological diagnosis and tailored vascular and wound care strategies.
• Interdisciplinary approaches combining vascular surgery, dermatology, and wound healing expertise are vital.
• Further research is needed for advanced treatments like skin equivalents in complex cases.