Skin Ulcers: Prevention and Diagnosis of Pressure, Venous Leg, and Arterial Ulcers

Pressure, venous leg, and arterial ulcers are common and costly skin conditions that affect patients in all clinical settings. Clinical features can help differentiate these ulcers. Pressure ulcers are associated with restricted mobility, poor perfusion, and compromised skin status. Venous leg ulcers (VLUs) are attributed to chronic venous hypertension resulting from venous insufficiency or obstruction. Risk factors for a first VLU include previous nonvenous leg ulcer, male sex, chronic venous hypertension, and older age. Arterial ulcers result from skin and soft tissue ischemia due to arterio-occlusive disease. They are associated with hypertension, diabetes, chronic kidney disease, and smoking. Various methods of pressure offloading have strong evidence of effectiveness in prevention of pressure ulcers. Clinical practice guidelines support the use of compression therapy in patients with previous VLUs to prevent ulcer recurrence. For patients with chronic lower extremity ulcers, a crucial step in evaluation is measurement of the ankle-brachial index, which can identify decreased perfusion and indicate the need for referral to a vascular surgeon. The likelihood of bone involvement should be determined. Skin and soft tissue infections often complicate wound care and should be addressed at each patient evaluation. Various factors can predict likelihood of wound healing.