Acta Scientific Medical Sciences (ISSN: 2582-0931)

Case Series Volume 4 Issue 8

Calf Pressure Ulcers: Facts Defying the Prevailing Concept

Jochanan E Naschitz1*, Segal Galit2, Zaygraykin Natalia3, Starikov Natalia3 and Leibovitz Gregory4

1Professor, Bait Balev Nesher, Department of Geriatric and Palliative Care, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
2Bait Balev Nesher, Department of Rehabilitation, Israel
3Department of Long-Term Mechanical Ventilation, Israel
4Department of Geriatric and Palliative Care, Israel

*Corresponding Author: Jochanan E Naschitz, Professor, Bait Balev Nesher, Department of Geriatric and Palliative Care, and The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.

Received: May 21, 2020; Published: July 09, 2020



Background: According to the classical concept the capillary closing pressure is 30 - 32 mmHg and the calf interface pressure is 10 - 20 mmHg. So, pressure ulcers cannot occur on the calf. Observations from the bedside oppose the concept.

Aim: To examine the features and clinical context of what appear to be calf pressure ulcers.

Design: Prospective observational study in a long-term geriatric and palliative care unit.

Methods: Guideline directed diagnosis and treatment of skin ulcers.

Results: Six out of 1631 patients newly admitted to our institution during a 15 month period had skin ulcers on their calves, resembling typical pressure ulcers. In four patients the calf ulcers evolved concurrently with pressure ulcers at other sites. Two patients had a single calf ulcer and no other pressure ulcer. By the ulcers' location, the clinical context and the normal appearance of the adjacent skin, the calf ulcers differed from venous, ischemic, neuropathic and vasculitic ulcers. Except for their elongated shape, contrasting to the round shape of pressure ulcers at other sites, the calf ulcers were similar to typical pressure ulcers. Calf pressure ulcers have been ignored in the literature, maybe as a consequence of the longtime dominant theory concerning pathophysiology of pressure injury. Recent studies have revised the classical concept, showing that tissue pressures can become critical at levels inferior to conventional capillary closure pressure, depending on systemic influences.

Conclusion: Six case histories provide evidence that calf ulcers may be genuine pressure ulcers and lend support to the contemporary, comprehensive theory of pressure injury.

Keywords: Ulcers; Capillaries; Pressure Injury



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Citation: Jochanan E Naschitz., et al. “Calf Pressure Ulcers: Facts Defying the Prevailing Concept". Acta Scientific Medical Sciences 4.8 (2020): 20-25.


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