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Distinguishing

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Arterial, Diabetic, & Vascular Ulcers

Arterial Ulcers Diabetic Ulcers Venous Ulcers


Predisposing Factors
Peripheral vascular Diabetic patient with Valve incompetence
disease (PVD) peripheral neuropathy in perforating veins
Diabetes mellitus History of deep vein
Advanced Age thrombophlebitis and
thrombosis
Previous history of
ulcers
Obesity
Advanced age
Anatomic Location
Between toes or tips On plantar aspect of On medial lower led
of toes foot and ankle
Over phalangeal Over metatarsal On malleolar area
heads heads
Around lateral Under heel
malleolus
At sites subjected to
trauma or rubbing of
footwear
Wound Characteristics
Even wound margins Even wound margins Irregular wound
Gangrene or necrosis Deep wound bed margins
Deep, pale wound Cellulitis or underlying Superficial wound
bed osteomyelitis Ruddy, granular
Blanched or purpuric Granular tissue tissue
periwound tissue present unless PVD is Usually no pain
Severe pain present Frequently moderate
Cellulitis Low to moderate to heavy exudate
Minimal exudate drainage
Patient Assessment
Thin, shinny, dry skin Diminished or absent Firm edema
Hair loss on ankle & sensation in foot Dilated superficial
foot Foot deformities veins
Thickened toenails Palpable pulses Dry, thin skin
Pallor on elevation Warm foot Evidence of healed
and dependent rubor Subcutaneous fat ulcers
Cyanosis atrophy Periwound and leg
Decreased hyperpigmintation
temperature Possible dermatitis
Absent or diminished
pulses