Risk factors
Leg trauma in the elderly, simply because of the changes in the skin and vessels associated with age itself, can become complicated even after mild trauma.
Dermatoporosis
- The term dermatoporosis includes the different manifestations and complications of skin fragility inherent to the physiological ageing process.
- Sun damage, prolonged treatment with topical or systemic corticosteroids, anticoagulant treatment, malnutrition and dehydration are exacerbating factors.
- Over-cleansing and over-frequency of dressing changes or misplaced bandages should be avoided
- Deep dissecting haematoma represents the highest degree of expression of dermatoporosis.
- Early diagnosis and proper management are essential to avoid potential complications and prolonged hospitalisation.
- The onset of this condition can be misdiagnosed with cellulitis, as it manifests with erythema, oedema and local heat.
- If the haematoma is not evacuated in this first phase, skin ischaemia occurs and an extensive eschar appears.
Arteriolosclerosis
- Arteriolosclerosis includes a spectrum of histological features such as thickening and loss of elasticity, calcifications and decreased caliber of the arterioles, which has a direct impact on possible impaired cutaneous microcirculation.
- The normal initial vasoconstriction after trauma may imply a compromise of tissue irrigation prolonged in time, since baseline cutaneous perfusion is already reduced with the consequent ischaemia. Subsequent vasodilatation starts a vicious cycle of necrosis-inflammation with the development of recalcitrant wounds.
Diagnosis of posttraumatic ulcers in the elderly due to arteriolosclerosis is clinical:
- Palpable pulses
- Necrotizing leg ulcers with livedoid edges
- Severe pain
- No response to conventional treatments
Treatment algorithm in traumatic leg ulcers
