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Importance
medical, social, pharmacoeconomic epidemiology, demography interdisciplinary collaboration, teamwork Centers for wound healing:
Leg ulcers Diabetic foot Decubites
Clinical examination
History and physical examination = fundamental
NO: circumstances of origin and duration OA: internal diseases, risk factors FA, GA, SA+PA RA: venous diseases
aspection- standing: edema, colour, trophic changes, varices palpation- lying: temperature, edema, pain subjective complains, alleviation manoeuvres history+ clinical picture determination of etiology knowledge of patgogenesis, diagnostic examinations and therapeutic possibilities adequate therapy
Varicous veins
dilatation, elongation, meander like shape epidemiology - race, sex, age, genetics population < 40 yrs. 30%, > 70 yrs. 10x classification - ethiology
primary secondary
classification - lumen
star burst reticular stem < 2 mm 2-4 mm > 4 mm
Posttrombotic syndroma
starburst varices
stem varices
phlebothrombosis
in 50% inappparent
supportive
CVI =
Pathogenesis of CVI
valves incompetence hypertension
capillary dilatation permeability
fluid, proteins, fibrinogen
blood flow
adhesion + migration leukocytes enzymes, ROS, MMP, cytokines
chronic inflammation
Classification of CVI
I. II. III. varices, reversible edema varices, permanent edema + trophic changes varices, edema+ trophic changes + ulcus CVI varices (scar)
Trophical changes:
hyperpigmentations hypodermitis dermosclerosis stasis dermatitis eczema verrucous hyperplasia white atrophy
corona phlebectatica
white atrophy
hemosiderin hyperpigmentations
arterial ulcer
diabetic gangrene
kalosities
diabetic ulcerations
Local Shape
ARTERIAL
METABOLIC NEUROPAT
Puls Perception / pain maleol bisar + + medial leg down frontal round 0, + leg cutted elevation acral round necrosis permanent
Complications of CVI
Contact allergic eczema Contact irritative dermatitis Microbial eczema 80 % Erysipelas Spinocellular cancer ulcus Marjolin
spinocellular cancer
Ulcer description
Wound assessment
Wound dressing
1. Classical : dressing gauze + ointment
2. Modern : wet wound healing = special materials:
humidity, exchange of gases and vapours, inpermeable for microorganisms, antiseptic
Insufficient healing
General factors: age, immunity, internal diseases, abusus; non - compliance Local factors: intensity and extent of vessel disease, ulcer localisation and size, infection. If impossible to eliminate/ reduce the cause = not healable ensure acceptable QoL
to be continued
Lymphedema
chronic solid edema = consequence of lymfatic system dysfunction lymphostasis + high proteins edema chronic inflammation + fibrosis solid complications: erysipelas, lymfangiosarcoma examination: sonography, lymphangioscintigraphy
Classification
Ethiology primary vessel dysplasia secondary non-/inflammatory obstruction Phases of edema: I. latent II. reversible III. ireversible IV. elephantiasis nostras
Erysipelas in lymphedema
Therapy of lymphedema
Symptomatic, prevent progresssion must be started early Decongestion
manual lymphodrainage Instrumental compressive bandages therapeutic exercices
Skin care, infection prophylaxis Systemic Surgical lymfovenous shunts, lymfo-liposuction, ablative