Leg ulcer L97.x0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

leg ulcer; Leg Ulcer; Lower leg ulcer

Definition
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Polyetiological skin defect (symptom) on the lower leg, which extends into the dermis or subcutis. At least the collagenous network of the reticular dermis is affected, but usually also deeper layers of the skin and subcutis. In complicated ulcers, the defect can also reach muscles, fascia and bony areas.

Classification
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Classification by aetiology:

Localization
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Depending on the etiology, there are preferred ulcer localizations.

Diagnosis
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Medical history, clinic, ultrasound Doppler examination, duplex sonography, light reflection rheography, arterial Doppler, laboratory parameters (blood sugar, factor XIII, zinc level), histology, X-ray image, phlebography, lymphography, arteriography.

Complication(s)
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  • Type IV sensitization to local therapeutic agents (especially to wool wax alcohols), risk of osteomyelitis in case of deep-reaching defects.
  • Marjolin ulcer: If a chronic leg ulcer persists for years, a malignant transformation cannot be excluded (Marjolin ulcer). In this case, squamous cell carcinomas with a poor prognosis develop, more rarely basal cell carcinomas.

Therapy
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See the respective clinical picture listed under Etiology.

Tables
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Etiology

Diseases

Frequency in inpatients (%)*

Frequency in non-selected patients (%)

Exclusively venous genesis

e.g. with CVI

17

70-80

Exclusively arterial genesis

e.g. with pAVK

1

4

Mixed venous-arterial

9,5

Other causes

9,5

Polyätiological

2-fold or 3-fold combinations of different causes (in total)

> 80

Venous and arterial genesis + vasculitis

17

Venous and arterial genesis + polyneuropathy

8

Other combination ulcers (bacterial infections, Pyoderma gangraenosum, artifacts, traumas of any kind)

> 50

Note(s)
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Remember: A leg ulcer is not a diagnosis but only a symptom!

Literature
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  1. Combemale P et al (2007) Malignant transformation of leg ulcers: a retrospective study of 85 cases. JEADV 21: 935-941
  2. King B (2004) Is this leg ulcer venous? Unusual aetiologies of lower leg ulcers. J Wound Care 13: 394-396
  3. Moffatt CJ, Frank's PJ (2004) Implementation of a leg ulcer strategy. Br J Dermatol 151: 857-867
  4. Mayer W, Jochmann W, Partsch H (1994) Varicose ulcer: healing in conservative therapy. A prospective study. Vienna Med Weekly 144: 250-252
  5. Rappoport L et al (2008) Occurrence of ulcer crurum in connection with the intake of Anagrelid. Act Dermatol 34: 132-134
  6. Stücker M et al. (2003) On the pathogenesis of therapy-resistant leg ulcers. Dermatologist 54: 750-755
  7. Trummer M et al (2002) Clinical relevance of + patch test reactions to lanolin alcohol. Contact Dermatitis 46: 118

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020