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1、各种溃疡的鉴别诊断,各种溃疡的鉴别诊断各种溃疡的鉴别诊断,各种溃疡的鉴别诊断各种溃疡的鉴别诊断各种溃疡的鉴别诊断,WOUND TYPES,ARTERIAL (ISCHEMIC) ULCERSVENOUS (VARICOSE, LEG,STASIS) ULCERSLYMPHEDEMA (CHRONIC DERMAL DISRUPTION) ULCERSPRESSURE (DECUBITUS) ULCERSLATE EFFECT OF TRAUMAUNCONTROLLED INFECTIONAUTOIMMUNE ULCERS (PSORIASIS,LUPUS, ETC),2,WOUND TYPES
2、ARTERIAL (ISCHEMIC,ELEMENTS COMMON TO MOST WOUNDS,VASCULAR COMPROMISE (ARTERIAL, VENOUS, MICROVASCULAR)REDUCED TISSUE OXYGEN CONCENTRATION (TCpO2)METABOLIC COMPROMISE,3,ELEMENTS COMMON TO MOST WOUNDS,ARTERIAL ULCERS,4,ARTERIAL ULCERS4,Arterial Ulcers,5,Arterial Ulcers5,ARTERIAL ULCERS,Usually have a
3、 “punched out” appearanceFull thickness defectMost often occurs in diabeticsMay be the result of embolic “showering” into the toesCan occur anywhere on the extremities,6,ARTERIAL ULCERS6,VENOUS ULCERS,7,VENOUS ULCERS7,Venous Ulcers,8,Venous Ulcers8,VENOUS ULCERS,Most often accompany varicose veinsMo
4、st often affect distal leg and ankleAre usually painful and heavily exudativeAre often recurrentExhibit varying depths, even within the same ulcerCan become huge,9,VENOUS ULCERS9,LYMPHEDEMA ULCERS,10,LYMPHEDEMA ULCERS10,LYMPHEDEMA ULCERS,Are invariably foul and dirtySurrounding skin is induratedAre
5、heavily exudativeCan expand to encompass the entire lower leg and top of the footAre usually infected with multiple organisms and yeastsOccur most often in association with obesity,11,LYMPHEDEMA ULCERS 11,PRESSURE ULCERS,12,PRESSURE ULCERS12,PRESSURE ULCERS,Can occur anywhere following sustained pre
6、ssureCan become life threateningAre often extremely foul and infected,13,PRESSURE ULCERS13,AUTOIMMUNE ULCERS,14,AUTOIMMUNE ULCERS14,AUTOIMMUNE ULCERS,Can mimic other ulcer typesAre often complicated with arterial/venous insufficienciesAre common with severe lupus, psoriasis and pemphigoid syndromesA
7、re frequently recurrent,15,AUTOIMMUNE ULCERS15,ULCERS OF MIXED ETIOLOGY,DIABETIC PLANTAR ULCER,BKA PRESSURE ULCER,DIABETIC/ARTERIAL ULCER,VENOUS/ARTERIAL ULCER,16,ULCERS OF MIXED ETIOLOGYDIABET,ULCERS OF MIXED ETIOLOGY,PRESSURE/VENOUS ULCER,VENOUS/ARTERIAL ULCER,PRESSURE/VENOUS/ARTERIAL,DIABETIC/PRE
8、SSURE ULCER,17,ULCERS OF MIXED ETIOLOGYPRESSU,CONCLUSIONS,Single-etiology ulcers are uncommonWe should suspect arterial involvement in any ulcer that is accompanied by diabetesVenous leg ulcers often have a pressure component and, in diabetics, an arterial compromiseAny ulcer may be compromised in the presence of autoimmune diseases,18,CONCLUSIONS18,谢谢观赏,谢谢观赏,
