In last month's column, "Checklist for Differential Diagnosis of Lower-Extremity Ulcers," I discussed that the clinician should suspect causes, other than venous insufficiency, for lower-leg ulcer presentation when the wound looks atypical (presence of necrotic tissue, exposed tendon, livedo reticularis on surrounding skin, or a deep, "punched-out" ulcer), has been present for longer than 6 months, or has not responded to good care. Complications associated with venous ulceration include the development of dermatitis, wound infection (bacterial and fungal), osteomyelitis, squamous cell carcinoma, and basal cell carcinoma. Venous ulceration can be further complicated by the presence of acute or chronic lipodermatosclerosis or arterial insufficiency.
Laboratory tests are a tool used when screening for the diagnoses illustrated in the previous column (Table 1). Remember, the key to treating any chronic wound is to address the underlying problem(s). Obtaining and reviewing appropriate laboratory tests are one more step for successful management.
At the end of the day, no matter how clinically competent we are, integrating checklists into our practice will improve our clinical and operational outcomes. If you have a checklist to share with our readership, please e-mail [email protected]. Good luck!