title: Uncommon leg ulcers in the lower extremity.
abstract: OBJECTIVE
  To determine the prevalence of uncommon ulcers, unrelated to venous or arterial etiology, in patients presenting to vascular clinics.
  
  
  METHODS
  This was a multicenter prospective study of consecutive patients presenting with lower extremity ulceration. The settings were university hospital outpatient centers and venous clinics. A total of 799 limbs in 710 patients with leg ulcers were evaluated. Patients with venous ulcer disease and with evidence of arterial disease with an ankle-brachial index less than 0.7 were excluded from the study. Out of 710 patients, 17 patients with a total of 21 limbs fit the criteria for inclusion. All limbs included in this study underwent physical examination, ankle-brachial index measurements, duplex ultrasonography, and skin biopsies.
  
  
  RESULTS
  The mean age of patients with uncommon ulcers was 65.6 years, and the mean duration was 5.5 years. A total of 2.1% of all leg ulcers seen were due to uncommon etiology unrelated to venous or arterial pathology. Most of these ulcers were located in the medial lower calf (n = 19). In six patients with ulcers, the histology did not reveal any specific cause; five had a neoplasia, three had chronic inflammation, two had sickle cell disease, two had vasculitis, one had rheumatoid arthritis, one had pyoderma gangrenosum, and one had ulcer due to hydroxyurea.
  
  
  CONCLUSIONS
  The prevalence of leg ulcers unrelated to arterial and venous disease that presented with signs and symptoms of chronic venous disease was 2.1%. Their etiology is variable, most often including vasculitis, neoplasia, metabolic disorders, infection, and other rare causes. Early identification of uncommon ulcers may facilitate timely and appropriate management.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL, USA. nlabrop@yahoo.com
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.forename: Danielle
authors.initials: D
authors.lastname: Manalo
authors.forename: Nima P
authors.initials: NP
authors.lastname: Patel
authors.forename: Jay
authors.initials: J
authors.lastname: Tiongson
authors.forename: Landon
authors.initials: L
authors.lastname: Pryor
authors.forename: Athanasios D
authors.initials: AD
authors.lastname: Giannoukas
mesh_terms: D000293:Adolescent; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001794:Blood Pressure; D001938:Brazil / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007871:Leg Ulcer / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D014481:United States / Q000453:epidemiology