WCE 17 Arterial Ulcers скачать в хорошем качестве

WCE 17 Arterial Ulcers

#ArterialUlcers #WoundCare #PeripheralArteryDisease #PAD #Ischemia #LegUlcers #VascularDisease #WoundHealing #LimbIschemia #ABPI #Revascularization #Angioplasty #BypassSurgery #DiabeticFoot This video provides an essential deep dive into arterial ulcers of the lower extremity, primarily drawing on information from "Wound Care Essentials". Arterial ulcers are wounds unable to heal due to insufficient oxygenated blood supply, essentially tissue starvation (ischemia). Poor blood flow is the fundamental underlying problem. These ulcers are a significant concern, particularly for older individuals, often indicating underlying artery problems in the legs. Diagnosis begins with a thorough patient history, including risk factors like diabetes (A1C), blood pressure, cholesterol, diet, exercise, and smoking (ABCDES mnemonic). A physical exam is crucial, looking for signs like pale or shiny skin, hair loss, thick toenails, cool temperature, dependent rubor (dusky red colour when leg is lowered), and importantly, checking pulses. Classic symptoms include claudication (cramping pain during walking that stops with rest) and the more severe rest pain (sharp, burning pain, often at night, relieved by hanging the foot down). Patients with neuropathy may not feel typical pain. Ulcers often have sharp, "punched out" borders and a pale, dry base. Gangrene (tissue death) is a severe sign. Objective tests are vital. The Ankle Brachial Pressure Index (ABPI) compares ankle systolic pressure to arm pressure; a normal range is 0.9-1.3, while lower numbers suggest disease. However, ABPI can be falsely high in people with calcified arteries (common in diabetes), making toe pressures or transcutaneous oxygen measurements (TCPO2) necessary. Segmental pressures help pinpoint blockage locations. Arteriography provides a detailed map for planning interventions but is invasive. Treatment focuses on improving blood flow whenever possible, coupled with tailored local wound care and aggressive risk factor management. For healable wounds, restoring flow via surgical bypass or endovascular procedures (angioplasty, stenting) is key. Local care for healable wounds includes debridement to remove unhealthy tissue. Dry, stable gangrene with poor flow should often be kept dry and not sharply debrided. Moist wound healing principles apply when blood flow is adequate or restored. Infection management involves distinguishing colonization from infection and using topical or systemic antimicrobials as needed. Risk factor management, especially smoking cessation and controlling diabetes, blood pressure, and cholesterol, is critical for preventing worsening disease and recurrence. Even without revascularization options, alternative approaches like hyperbaric oxygen therapy combined with debridement can sometimes aid healing. Tracking healing progress is important, with a 20-40% size reduction in four weeks being a positive sign. Patient education is vital throughout the process.