Brojni su uzroci nastanka ulkusa na donjim ekstremitetima. Najčešći je venski ulkus u bolesnika s kroničnom venskom insuficijencijom. rjeđa je pojava arterijskog ulkusa, koji je posljedica periferne okluzivne bolesti arterija, najčešće ateroskleroze. Dio ulkusa posljedica je kombinacije periferne okluzivne bolesti arterija i kronične venske insuficijencije. u sklopu dijabetesa melitusa i dijabetičke neuropatije javlja se ulcus neurotrophicus. Posljedica je distalne, simetrične neuropatije i periferne okluzivne bolesti arterija. osim u vaskularnih, neuropatskih i metaboličkih bolesti ulkus se pojavljuje i u sklopu hematoloških, autoimunih, genetskih, infektivnih i primarnih bolesti kože, neoplazmi, kod primjene nekih lijekova, terapijskih postupaka i djelovanja drugih vanjskih čimbenika. Pri utvrđivanju etiologije koristimo se anamnezom, inspekcijom, palpacijom, testovima kojima utvrđujemo vensku insuficijenciju i perifernu okluzivnu bolest arterija. ulkusi različite etiologije mogu imati istu ili sličnu kliničku sliku te je potrebno provesti dodatne dijagnostičke pretrage: iz krvi, uzorka tkiva [mikrobiološka, mikološka analiza, patološko histološke analize (PHD), direktna imunofluorescentna pretraga (DIF)]. koriste se pretrage uz uporabu medicinskih aparata: mjerenje gležanjskog indeksa (ankle brachial pressure indeks - AbPI), ultrazvučne pretrage, pletizmografija, MSCT i Mr angiografija, digitalna supstracijska angiografija (DSA), arteriografija, venografija, limfoscintigrafija, radiološka pretraga te kapilaroskopija. osim mikrobiološke analize rane ne postoje pretrage koje bi mogle dati točnu informaciju o statusu same rane.Many factors contribute to the pathogenesis of leg ulcer. Most patients have venous leg ulcer due to chronic venous insufficiency. Less often, patients have arterial leg ulcer resulting from peripheral arterial occlusive disease, the most common cause of which is arteriosclerosis. Leg ulcer may be of a mixed arteriovenous origin. In diabetic patients, distal symmetric neuropathy and peripheral vascular disease are probably the most important etiologic factors in the development of diabetic leg ulcer. Other causes of chronic leg ulcers are hematologic diseases, autoimmune diseases, genetic defects, infectious diseases, primary skin diseases, cutaneous malignant diseases, use of some medications and therapeutic procedures, and numerous exogenous factors. Diagnosis of leg ulcer is based on medical history, inspection, palpation of skin temperature, palpation of arteries, fascia holes, presence and degree of edema, firm painful cords, and functional testing to assess peripheral occlusive arterial disease or identify superficial and deep venous reflux of the legs. Knowledge of differential diagnosis is essential for ensuring treatment success in patients with leg ulcer. There are many possible etiologic factors of leg ulcers and sometimes, clinical findings are similar. Additional testing should be performed, e.g.,serologic testing such as blood count, C-reactive protein, HBA1c, erythrocyte sedimentation rate, differential blood count, total proteins, electrolytes, coagulation parameters, circulating immune complex, cryoglobulins, homocysteins, AT, PAI-1, APC resistance, proteins C and S, paraproteins, ANA, ENA, ANCA, dsDNA, antiphospholipid antibodies, urea, creatinine, blood lipids, vitamins and trace elements. Also, biopsy of the lesion for histopathology, direct immunofluorescence, bacteriology and mycology should be included. Other tests are Raynaud (cold stimulation) test and pathergy test. Device-based diagnostic testing should be performed for future clarification. Ankle brachial pressure index, color duplex sonography, plethysmography, MSCT and MR angiography, digital subtraction angiography, phlebography, angiography, x-ray, and capillaroscopy in lupus erythematosus are indicated. Except for bacteriologic analyses of wound biopsies, there is no test to provide specific information on the wound condition
