Lower limb ulceration

The diagnosis of lower limb ulceration must start by determining the patient s full clinical history, together with a physical examination of the condition. It is essential to identify possible risk factors that could cause ulceration or impact on the treatment of the ulcer. These risk factors could include arterial insufficiency, trauma, diabetes, sickle cell disease, infection, malignancy, and inflammatory disorders. ... 

Vowden, P. and Vowden, K. (2001) Investigations in the management of lower limb ulceration. Br 7 Aitrs, The Profore Supplement, 4,627. 

Signs and Symptoms High fever coughing thick nasal discharge rapidly spreading, deep ulceration of the nasal mucosa submaxillary lymph nodes swollen and painful nodules on the skin, abdomen, and lower limbs death in 1-2 weeks. In the cutaneous form, the lymphatics are enlarged and nodular abscesses ("buds") of 0.5-2.5 cm develop, which ulcerate and discharge yellow oily pus. 

An infected foot ulcer precedes approximately 60% of lower limb amputations in the diabetic population [13], thus the rapid and appropriate treatment of soft tissue infection is paramount. There is substantial evidence suggesting that people with diabetes are more susceptible to infection due to altered immune-response [14]. Polymorphonuclear neutrophil oxidative burst activity is thought to be reduced in addition to decreased bacterial killing... 

Marino, G., Moraci, M., Armenia, E., Orabona, C., Sergio, R., De Sena, G., Capuozzo, V., Barbarisi, M., Rosso, F., Giordano, G., lovino, E., Barbarisi, A. Therapy with autologous adipose-derived regenerative cells for the care of chronic ulcer of lower limbs in patients with peripheral arterial disease. The Journal of Surgical Research 185, 36-44 (2013)... 

When venous valves are weakened and allow regurgitation of blood, there is an abrupt increase in venous pressure (Alguire and Mathes, 1997 Beebe-Dimmer et al., 2005 Hjelmstedt, 1968). The increased pressure and resulting venous hypertension are the primary cause of chronic venous insufficiency (CVI) (Belcaro et al., 1989 Browse, 1986 Browse and Bumand, 1982 Hjelmstedt, 1968). The continued prevalence of hypertension leads to dilation of the incompetent veins, resulting in varicose veins like those shown in Figure 20.12, the most conunon manifestation of CVI (Alguire and Mathes, 1997 Bhutia et al., 2008 McLafferty et al., 2007). If left untreated, CVI can cause dramatic cosmetic changes in skin, lower limb pain, edema, deep vein thrombosis, and ulcers (Adhikari et al., 2000 McLafferty et al., 2007 Robertson et al., 2008 Schoonover et al., 2009 Tran and Meissner, 2002 Van Den Bos and... 

Nick J. M. London and Richard Donnelly, ABC of Arterial and Venous Disease Ulcerated Lower limb, BMJ 2000 320 1589-1591. 

Diabetic wound is a complication of diabetes mellitus which is characterised by the slow healing of normal wounds specially produced at the body extremities leading to diabetic foot ulceration etc. It leads to approximately 20% cases of hospitalisation, amputations, morbidity and 50% of non-traumatic lower limb amputations [10, 11]. Diabetic wounds are accelerated by the microorganisms like Staphyloccocus aureus. Pseudomonas, Streptococci etc. [11]. Medicinal plants have been extensively used for thousands of years to cure ailments like diabetes, blood pressure, infection etc. Herbal, Unani, Chinese, traditional or folklore all state the beneficial effects of such plants [12, 13]. 

---