Question

5. What is the difference between arterials ulcers versus venous stasis ulcers versus pressure injury (aka pressure ulcers)? (typed please).

Answer 1

Skin covers all over the body. Skin forms a barrier between internal organs and external environment and participates in many vital body functions.Skin has three layers epidermis, dermis and subcutaneous. The skin is a reflection of person 's overall health , and alterations commonly correspond to disease in other organ systems. When there is indequate blood supply, decreased nourishment to skin may lead to tissue damage.

Arterial ulcer:

Poorly nourished tissues are susceptible to damage and infection. When lesions develop , healing may be prolonged or inhibited because of the poor blood supply to the area.The arteries carry oxygenated blood and nutrients all over the body . Narrowing of artery or any underlying pathology(damage to blood vessels) causing restriction in the blood supply leads to open wound and necrosis of tissues These are called venous ulcers or ischemic ulcers. Infected, non healing ulcerations of the extremities can be debilitating and require expensive treatments. Amputation may be necessary if the condition worsens.

This ulcers causes excruciating pain which is even unrelieved by opioids. It worsens at night. The skin may be shiny , atrophic, and dry, with sparse hair growth.The extremities feels cold to touch and numbness accompanies. Unequal pulses between extremities or absence of a normally palpable pulse occur.The ulcers often are small, circular , deep on the tips of toes and occur on medial side of hallux or lateral fifth toe .

Venous stasis ulcer:

About 75% of leg ulcers result from venous stasis.When the veins weaken due to any pathological condition like hypertension, deep vein thrombosis, etc and so the cellular metabolism cannot maintain energy balance . Chronic venous insufficiency leads to stasis of blood in veins. It is characterised by aching and heaviness. Foot and ankle seems edematous. Ulcerations occur on side of the foot over metatarsal heads. These are painless ulcers. Wound debridement can done to clean the necrotic tissue formed to enhance healing.This can be effectively managed.

Pressure ulcers:

Pressure ulcers are common among bedridden patients or who cannot move on their own.It is also termed as decubitus ulcers or bedsores or pressure sores. This occurs mainly in pressure areas like bony prominences,  the heels, hips, and buttocks due to shear and friction . Bed sores may even lead to death as this wounds are easily infected .The pressure in the area decreases the circulation ending in inadequate nourishment to underlying skin leads to redness and break in skin.