CHRONIC WOUNDS: DIFFERENTIAL DIAGNOSIS

Abstract

Rana je prekid anatomskog i funkcionalnog kontinuiteta tkiva, a s obzirom na tijek cijeljenja rane dijelimo na akutne i kronične. kronična rana je rana koja unatoč standardnom medicinskom postupku ne cijeli očekivanom dinamikom, odnosno u užem smislu rana koja ne cijeli unutar 6 tjedana. kronične rane mogu biti tipične i atipične. u tipične rane ubrajaju se ishemijske, neurotrofičke i hipostatske rane te dva posebna entiteta: dekubitus i dijabetičko stopalo. kronične rane na potkoljenicama su u 80 % slučajeva posljedica kronične venske insuficijencije, u 5-10 % su arterijske etiologije, dok ostatak otpada uglavnom na neuropatske ulkuse. Kao jedan od prije navedenih kliničkih entiteta manifestira se 95 % kroničnih rana. ostali oblici kroničnih rana manifestiraju se kao atipične kronične rane, a mogu biti uzrokovane autoimunim poremećajima, infektivnim bolestima, bolestima krvnih žila i vaskulopatijama, metaboličkim i genetskim bolestima, malignim bolestima, vanjskim uzrocima, psihičkim bolestima, reakcijama na lijekove i dr. Iako su atipične rane rijetko uzrok kronične rane, treba na njih pomišljati u diferencijalnoj dijagnozi.Wound is a disruption of anatomic and physiologic continuity of the skin. According to the healing process, wounds are classified as acute and chronic wounds. A wound is considered chronic if standard medical procedures do not lead to the expected healing, or if the wound does not heal within six weeks. Chronic wounds are classified as typical and atypical. Typical wounds include ischemic, neurotrophic and hypostatic wounds. Diabetic foot and decubitus ulcers stand out as a specific entity among typical wounds. About 80 percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the remainder are mostly neuropathic ulcers. About 95 percent of chronic wounds manifest as one of the above-mentioned entities. Other forms of chronic wounds are atypical chronic wounds, which can be caused by autoimmune disorders, infectious diseases, vascular diseases and vasculopathies, metabolic and genetic diseases, neoplasm, external factors, psychiatric disorders, drug related reactions, etc. Numerous systemic diseases can present with atypical wounds. The primary cause of the wound can be either systemic disease itself (Crohn’s disease) or aberrant immune response due to systemic disease (pyoderma gangrenosum,paraneoplastic syndrome). Although atypical wounds are a rare cause of chronic wounds, it should always be taken in consideration during diagnostic procedure

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