A STUDY OF PREVALENCE, CLINICAL PRESENTATION AND MANAGEMENT OF LOWER LIMB ULCERS AT A TERTIARY HOSPITAL

Background: Lower limb ulcers are debilitating and painful, greatly reducing patients quality of life. These ulcers are often difficult to treat. The most common aetiologies for lower limb ulcers are venous, arterial, mixed venous and arterial, diabetic and pressure ulcers. However, atypical wounds comprise approximately 20% of chronic wounds and should be kept in mind during differential diagnosis.The successful ulcer management depends upon the accurate diagnosis and treatment of the underlying cause, and it often needs a multidisciplinary approach. Methods: This prospective cross-sectional study conductedin Department of General Surgery atBasaveshwara Teaching and General Hospital, Attached to Mahadevappa Rampure Medical College, Kalaburagi. The study was conducted during the period from June 2022 to December 2023 which included 97 patients presenting withlower limb ulcers and admitted in surgical wards of our hospital. Results: Most of the patients were engaged in agriculture (24%) followed by business (23%) and service (14%). 47.5% of the patients had habit of smoking,alcohol consumption and tobacco chewing. Most of the ulcers were diabetic (36.1%) followed by venous (22.6%) (Z=2.17 p=0). Only 4.1% and 3.1% were malignant and trophic ulcers. Peripheral neuropathy (26.8%) was the most common cause of ulcer followed by venous hypertension (24.7%).In most of the cases, debridement with dressing (32.9%) and Debreidment+dressing+skin grafting (19.6%) was done. At the end of study period, 90 ulcers were healed, 4 were disease free, 2 had recurrence and 1 patient died. Conclusion:A comprehensive assessment of patients general status, personal habits, skin, vascular status, limb, ulcer characteristics are required to determine the etiology and to formulate effective treatment plan. Thus, the study of various cases of lower limb ulcers arouses lot of interest and is mind boggling as far as the treatment of these cases are concerned. With the availability of arsenal of investigation, wide range of antibiotics and with ever improving dressing material, there is certainly a great improvement in treatment of lower limb ulcers. Education and training are vital for all those involved in caring of patients with ulcer.

背景：下肢溃疡（lower limb ulcers）具有致残性且伴随剧烈疼痛，会大幅降低患者的生活质量，且往往治疗难度极大。下肢溃疡最常见的病因学（aetiologies）类型包括静脉性、动脉性、混合性动静脉、糖尿病性及压力性溃疡。不过非典型伤口约占慢性伤口（chronic wounds）的20%，在鉴别诊断（differential diagnosis）过程中需予以警惕。溃疡的成功诊疗有赖于对潜在病因的精准诊断与针对性治疗，且通常需要多学科诊疗模式（multidisciplinary approach）。
方法：本前瞻性横断面研究于印度卡拉布拉吉市马哈德瓦帕·兰普尔医学院附属巴沙维什瓦拉教学综合医院普通外科开展，研究周期为2022年6月至2023年12月，共纳入97例因下肢溃疡收治于本院外科病房的患者。
结果：大部分患者从事农业（24%），其次为商业（23%）与服务业（14%）。47.5%的患者存在吸烟、饮酒及咀嚼烟草的不良习惯。最常见的溃疡类型为糖尿病性溃疡（36.1%），其次为静脉性溃疡（22.6%）（Z=2.17，P=0）。恶性溃疡与营养性溃疡（trophic ulcers）占比仅为4.1%与3.1%。周围神经病变（peripheral neuropathy）是最常见的溃疡诱因，其次为静脉高压（venous hypertension）。多数患者接受了清创（debridement）联合换药治疗（32.9%），以及清创+换药+植皮术（skin grafting）（19.6%）。研究结束时，90处溃疡实现愈合，4例患者达到无病生存，2例出现复发，1例患者死亡。
结论：需全面评估患者的全身状况、个人习惯、皮肤与血管状态、肢体及溃疡特征，以明确病因并制定有效的治疗方案。因此，下肢溃疡各类病例的研究极具临床价值，其诊疗过程亦颇具挑战性。随着各类检查手段、广谱抗生素及不断更新的敷料材料的应用，下肢溃疡的治疗水平已有显著提升。对所有参与溃疡患者护理的医护人员而言，教育培训至关重要。