1400_Trepal.pdf

1、When To Biopsy an UlcerMichael J.Trepal,DPM,FACFASVP for Academic Affairs and DeanNew York College of Podiatric MedicineDisclosuresI Have no relevant financial interests to disclose.Learning Objectives1.Review Various Etiologies of Pedal Ulcerations2.Discuss the Indications for Biopsy of a Pedal Ulc

2、eration3.Review Biopsy Techniques for Pedal UlcerationsPossible Explanations for ulcers Trauma Moisture Infection Impaired Blood flow Pressure Neuropathy Neoplasm Inflammation Temperature extremesApproach to Patient With An UlcerObtain History of Onset and ChronicityApproach to Patient With An Ulcer

3、 Obtain History of Onset and Chronicity Comprehensive Medical History DM CVD/PAD Venous Disease/VTE CKD Autoimmune Inflammatory Bowel Disease Connective Tissue Disease Medications UsedApproach to Patient With An UlcerObtain Social History Comprehensive Medical HistorySmokingOccupationPostural Positi

4、onsFrostbiteRadiator BurnChronic wounds in Spite of“Optimal”Treatment May Remain in a Non-Healing Trajectory.Less Common ThingsInfectionInfectionSyphilisTBMadura FootVasculitisSmall Vessels AutoimmuneRheumatoidSLESclerodermaRASclerodermaIBSPyoderma GangrenosumTAO:Buergers DiseaseArterial EmboliEndoc

5、arditisArterial PlaqueArterial EmboliAtrial FibrillationCryoglobulinemiaCalciphylaxisNSFSickle CellNeoplasticEccrine PoromaVerrucous CaSquamous Cell CaKaposis 56 Year Old Female Non DM No PAD 1 x 2 cm Palpable STM Two Separate Biopsy Granulation Tissue 65 Year Old Female Pre-Diabetic Non Healing Wou

6、nd for 6 WeeksChronic Wounds and Malignancy Primary Cancer Wounds degenerating Into Cancer Systemic Malignancy with skin Infiltrates Ulcers resulting from Treatment of MalignanciesChronic Wounds and Malignancy Primary Cancer Wounds Degenerating Into Cancer Systemic Malignancy with skin Infiltrates U