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Ulcer of lower limbs

MedGen UID:
9701
•Concept ID:
C0023223
•
Disease or Syndrome
Synonyms: Leg Ulcer; Leg Ulcers; Ulcer, Leg; Ulcers, Leg
SNOMED CT: Ulcer of lower extremity (95344007); Ulcer of lower limb (95344007); Leg ulcer (95344007)
 
Monarch Initiative: MONDO:0004601

Definition

A circumscribed, inflammatory, and often suppurating lesion that causes necrosis of tissue on the skin of the limb comprising the hip, thigh, leg and foot. [from NCI]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVUlcer of lower limbs

Professional guidelines

PubMed

Chronic Wounds: Evaluation and Management.
Bowers S, Franco E
Am Fam Physician 2020 Feb 1;101(3):159-166. PMID: 32003952
Venous Ulcers: Diagnosis and Treatment.
Bonkemeyer Millan S, Gan R, Townsend PE
Am Fam Physician 2019 Sep 1;100(5):298-305. PMID: 31478635
The diabetic foot: Pathophysiology, evaluation, and treatment.
Bandyk DF
Semin Vasc Surg 2018 Jun-Dec;31(2-4):43-48. Epub 2019 Feb 6 doi: 10.1053/j.semvascsurg.2019.02.001. PMID: 30876640

Recent clinical studies

Etiology

Diabetic Foot Ulcers: A Review.
Armstrong DG, Tan TW, Boulton AJM, Bus SA
JAMA 2023 Jul 3;330(1):62-75. doi: 10.1001/jama.2023.10578. PMID: 37395769Free PMC Article
Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers.
McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW
Diabetes Care 2023 Jan 1;46(1):209-221. doi: 10.2337/dci22-0043. PMID: 36548709Free PMC Article
Lower Extremity Ulcers.
Schneider C, Stratman S, Kirsner RS
Med Clin North Am 2021 Jul;105(4):663-679. doi: 10.1016/j.mcna.2021.04.006. PMID: 34059244
Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia.
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S; GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS)
Eur J Vasc Endovasc Surg 2019 Jul;58(1S):S1-S109.e33. Epub 2019 Jun 8 doi: 10.1016/j.ejvs.2019.05.006. PMID: 31182334Free PMC Article
Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation.
Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES
Int Wound J 2017 Jun;14(3):537-545. Epub 2016 Oct 10 doi: 10.1111/iwj.12642. PMID: 27723246Free PMC Article

Diagnosis

Diabetic Foot Ulcers: A Review.
Armstrong DG, Tan TW, Boulton AJM, Bus SA
JAMA 2023 Jul 3;330(1):62-75. doi: 10.1001/jama.2023.10578. PMID: 37395769Free PMC Article
Lower Extremity Ulcers.
Schneider C, Stratman S, Kirsner RS
Med Clin North Am 2021 Jul;105(4):663-679. doi: 10.1016/j.mcna.2021.04.006. PMID: 34059244
Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes.
Hicks CW, Selvin E
Curr Diab Rep 2019 Aug 27;19(10):86. doi: 10.1007/s11892-019-1212-8. PMID: 31456118Free PMC Article
Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia.
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S; GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS)
Eur J Vasc Endovasc Surg 2019 Jul;58(1S):S1-S109.e33. Epub 2019 Jun 8 doi: 10.1016/j.ejvs.2019.05.006. PMID: 31182334Free PMC Article
Chronic venous insufficiency and varicose veins of the lower extremities.
Youn YJ, Lee J
Korean J Intern Med 2019 Mar;34(2):269-283. Epub 2018 Oct 26 doi: 10.3904/kjim.2018.230. PMID: 30360023Free PMC Article

Therapy

Diabetic Foot Ulcers: A Review.
Armstrong DG, Tan TW, Boulton AJM, Bus SA
JAMA 2023 Jul 3;330(1):62-75. doi: 10.1001/jama.2023.10578. PMID: 37395769Free PMC Article
Phlebotonics for venous insufficiency.
Martinez-Zapata MJ, Vernooij RW, Simancas-Racines D, Uriona Tuma SM, Stein AT, Moreno Carriles RMM, Vargas E, Bonfill Cosp X
Cochrane Database Syst Rev 2020 Nov 3;11(11):CD003229. doi: 10.1002/14651858.CD003229.pub4. PMID: 33141449Free PMC Article
Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia.
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH, Aboyans V, Aksoy M, Alexandrescu VA, Armstrong D, Azuma N, Belch J, Bergoeing M, Bjorck M, Chakfé N, Cheng S, Dawson J, Debus ES, Dueck A, Duval S, Eckstein HH, Ferraresi R, Gambhir R, Gargiulo M, Geraghty P, Goode S, Gray B, Guo W, Gupta PC, Hinchliffe R, Jetty P, Komori K, Lavery L, Liang W, Lookstein R, Menard M, Misra S, Miyata T, Moneta G, Munoa Prado JA, Munoz A, Paolini JE, Patel M, Pomposelli F, Powell R, Robless P, Rogers L, Schanzer A, Schneider P, Taylor S, De Ceniga MV, Veller M, Vermassen F, Wang J, Wang S; GVG Writing Group for the Joint Guidelines of the Society for Vascular Surgery (SVS), European Society for Vascular Surgery (ESVS), and World Federation of Vascular Societies (WFVS)
Eur J Vasc Endovasc Surg 2019 Jul;58(1S):S1-S109.e33. Epub 2019 Jun 8 doi: 10.1016/j.ejvs.2019.05.006. PMID: 31182334Free PMC Article
Exercise and Chronic Wound Healing.
Bolton L
Wounds 2019 Feb;31(2):65-67. PMID: 30694211
Varicose veins of lower extremities, hemodynamics and treatment methods.
Chwała M, Szczeklik W, Szczeklik M, Aleksiejew-Kleszczyński T, Jagielska-Chwała M
Adv Clin Exp Med 2015 Jan-Feb;24(1):5-14. doi: 10.17219/acem/31880. PMID: 25923081

Prognosis

Lower Extremity Ulcers.
Schneider C, Stratman S, Kirsner RS
Med Clin North Am 2021 Jul;105(4):663-679. doi: 10.1016/j.mcna.2021.04.006. PMID: 34059244
Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation.
Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES
Int Wound J 2017 Jun;14(3):537-545. Epub 2016 Oct 10 doi: 10.1111/iwj.12642. PMID: 27723246Free PMC Article
Pathogenesis of venous ulcer.
Comerota A, Lurie F
Semin Vasc Surg 2015 Mar;28(1):6-14. Epub 2015 Jul 17 doi: 10.1053/j.semvascsurg.2015.07.003. PMID: 26358304
Varicose veins of lower extremities, hemodynamics and treatment methods.
Chwała M, Szczeklik W, Szczeklik M, Aleksiejew-Kleszczyński T, Jagielska-Chwała M
Adv Clin Exp Med 2015 Jan-Feb;24(1):5-14. doi: 10.17219/acem/31880. PMID: 25923081
The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).
Mills JL Sr, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G; Society for Vascular Surgery Lower Extremity Guidelines Committee
J Vasc Surg 2014 Jan;59(1):220-34.e1-2. Epub 2013 Oct 12 doi: 10.1016/j.jvs.2013.08.003. PMID: 24126108

Clinical prediction guides

Diabetic Foot Ulcers: A Review.
Armstrong DG, Tan TW, Boulton AJM, Bus SA
JAMA 2023 Jul 3;330(1):62-75. doi: 10.1001/jama.2023.10578. PMID: 37395769Free PMC Article
Lower Extremity Ulcers.
Schneider C, Stratman S, Kirsner RS
Med Clin North Am 2021 Jul;105(4):663-679. doi: 10.1016/j.mcna.2021.04.006. PMID: 34059244
Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation.
Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES
Int Wound J 2017 Jun;14(3):537-545. Epub 2016 Oct 10 doi: 10.1111/iwj.12642. PMID: 27723246Free PMC Article
Varicose veins of lower extremities, hemodynamics and treatment methods.
Chwała M, Szczeklik W, Szczeklik M, Aleksiejew-Kleszczyński T, Jagielska-Chwała M
Adv Clin Exp Med 2015 Jan-Feb;24(1):5-14. doi: 10.17219/acem/31880. PMID: 25923081
The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).
Mills JL Sr, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G; Society for Vascular Surgery Lower Extremity Guidelines Committee
J Vasc Surg 2014 Jan;59(1):220-34.e1-2. Epub 2013 Oct 12 doi: 10.1016/j.jvs.2013.08.003. PMID: 24126108

Recent systematic reviews

Does exercise improve healing of diabetic foot ulcers? A systematic review.
Tran MM, Haley MN
J Foot Ankle Res 2021 Mar 20;14(1):19. doi: 10.1186/s13047-021-00456-w. PMID: 33743791Free PMC Article
Phlebotonics for venous insufficiency.
Martinez-Zapata MJ, Vernooij RW, Simancas-Racines D, Uriona Tuma SM, Stein AT, Moreno Carriles RMM, Vargas E, Bonfill Cosp X
Cochrane Database Syst Rev 2020 Nov 3;11(11):CD003229. doi: 10.1002/14651858.CD003229.pub4. PMID: 33141449Free PMC Article
A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency.
Orr L, Klement KA, McCrossin L, O'Sullivan Drombolis D, Houghton PE, Spaulding S, Burke S
Ostomy Wound Manage 2017 Aug;63(8):30-43. doi: 10.25270/owm.2017.08.3043. PMID: 28873064
Topical antimicrobial agents for treating foot ulcers in people with diabetes.
Dumville JC, Lipsky BA, Hoey C, Cruciani M, Fiscon M, Xia J
Cochrane Database Syst Rev 2017 Jun 14;6(6):CD011038. doi: 10.1002/14651858.CD011038.pub2. PMID: 28613416Free PMC Article
Mortality After Nontraumatic Major Amputation Among Patients With Diabetes and Peripheral Vascular Disease: A Systematic Review.
Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC
J Foot Ankle Surg 2016 May-Jun;55(3):591-9. Epub 2016 Feb 19 doi: 10.1053/j.jfas.2016.01.012. PMID: 26898398

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