Epidemiology and Pathophysiology of Venous Ulcers

A shift in the etiology of chronic leg ulcers from venous to mixed venous-arterial to arterial to neuropathic-ischemic ulcers has taken place. The incidence and prevalence of, pure" venous leg ulcers declines. Only about 40-50% of these ulcers are caused by venous cause alone. Mixed venous-arterial ulcers are on the increase. 20% of all patients with an ulcus cruris show a relevant arterial obstructive disease, which has to be treated first of all. The pure arterial ulcers are located over the lateral malleolus typically. They represent about 3-5% of all ulcers. Additional 35% are caused by the hypertensive-ischemic ulcus Martorell with an increasing incidence. The typical presentation of the ulcus Martorell is a necrosis of the skin on the laterodorsal lower leg. An arterial hypertension and an obliterative subcutaneous arteriolosclerosis is a precondition for the diagnosis. About 10% of the chronic ulcers of the lower leg are caused by rare conditions (malignancies, vasculitis). No etiology is found in about 5%.