An ulcer is a loss of cutaneous substance of slow development and many times recurring.
These types of ulcers usually develop especially in the lower third of the leg, both in the external as well as internal facets frequently near the malleolus, even at the height of this, in which case the scarring will be even more difficult.
The size of the ulcers varies, they can become very large. Their aspect and coloring enable us to determine their age and to make a prognosis.
If they are gray, healthy and with deep borders, they have a poor prognosis of scarring, if the bottom is purulent, of greenish yellow color, the ulcer can become infected with very diverse germs. If on the contrary, they have a clean bottom, with red granulation, fine borders, elastic and with epidermal border, their prognosis will be more favorable.
Types of ulcers
- Varicose ulcer: Usually located in the dorsum of the foot and on the internal malleolus. Its characteristic presents with disturbances to standing, white atrophy, yellowish brown pigmentation, etc.
- Postphlebitis ulcer: usually is located mostly on the internal maleolar. It presents with disturbances to orthostatic hypotension, a red bottom, irregular borders.
- Hypertensive ulcers: Located in the antero-external facet of the lower third of the leg, they are infrequent, usually painful and difficult to cure.
- Diabetic ulcers:
- 1. Macroangiopathy: large vessel disease similar to the arteriosclerotic ones, but with a greater capacity of getting infected
- 2. Microangiopathy: small vessel disease, these appear spontaneously or by a slight trauma (callus, chafing, abrasion)
In both cases they are located in the digital areas and areas of chafing and usually vary in size, deep and round, with a red bottom and relatively painful
3. Neuropathic: these are located in the metatarsalphalangeal joints of the first and fifth toes in the plantar zone. They vary in size, are painless and can be in depth surrounded by hyperkeratoses
The treatment of leg ulcers has evolved considerably in recent years and presently is at the disposal of numerous options. Independent of the type of ulcer, the therapeutic regimen can be broken down into four phases: the fight against infection, cleanliness, granulation and epidermization.
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