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.
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