{"id":22623,"date":"2018-11-07T17:43:14","date_gmt":"2018-11-07T16:43:14","guid":{"rendered":"https:\/\/saintjoseph.agepcom.fr\/?post_type=service&#038;p=12412"},"modified":"2022-04-21T15:53:44","modified_gmt":"2022-04-21T13:53:44","slug":"ulceres-de-jambe","status":"publish","type":"service","link":"https:\/\/devhml.givememore.net\/specialites\/medecine-vasculaire-phlebologie\/pathologies\/ulceres-de-jambe\/","title":{"rendered":"Ulc\u00e8res de jambe"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"plaie-chronique-evoluant-depuis-plus-de-4-semaines-situee-entre-le-genou-et-le-pied\">Plaie chronique \u00e9voluant depuis plus de 4 semaines, situ\u00e9e entre le genou et le pied.<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">C\u2019est une pathologie fr\u00e9quente puisqu\u2019elle concerne 2% des patients de plus de 70 ans. Elle est chronique (dur\u00e9e de cicatrisation de plus de six mois dans 40% des cas) et douloureuse dans 75% des cas.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">L&rsquo;ulc\u00e8re de jambe doit \u00eatre consid\u00e9r\u00e9 comme un <strong>sympt\u00f4me<\/strong>, expression au niveau de la peau d&rsquo;une maladie vasculaire le plus souvent. La cause <strong>vasculaire<\/strong> peut \u00eatre : veineuse, art\u00e9rielle, art\u00e9rielle et veineuse, microcirculatoire.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La prise en charge des plaies chroniques fait appel \u00e0 des techniques innovantes (traitement par pression n\u00e9gative) et \u00e0 des techniques confirm\u00e9es comme la greffe cutan\u00e9e en pastilles, associ\u00e9es au traitement \u00e9tiologique (cure de varices, compression adapt\u00e9e, angioplastie des art\u00e8res p\u00e9riph\u00e9riques, pontages art\u00e9riels).<br>Les greffes de peau en pastilles sont r\u00e9alisables simplement, au lit du patient, parfois en h\u00f4pital de jour, sous anesth\u00e9sie locale. Leur effet antalgique est g\u00e9n\u00e9ralement imm\u00e9diat.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pour favoriser sa prise, la greffe peut \u00eatre pr\u00e9c\u00e9d\u00e9e d&rsquo;une phase d&rsquo;auto-h\u00e9moth\u00e9rapie par application sur l&rsquo;ulc\u00e8re sous occlusion de quelques gouttes de sang frais h\u00e9parin\u00e9 pr\u00e9lev\u00e9 par une simple prise de sang faite au patient, ou de l\u2019utilisation d\u2019un appareil \u00e0 pression n\u00e9gative appliqu\u00e9 sur la plaie pour stimuler la cicatrisation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"les-differents-types-d-ulceres\">Les diff\u00e9rents types d&rsquo;ulc\u00e8res<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"ulceres-veineux\">Ulc\u00e8res veineux<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Les arguments pour un ulc\u00e8re veineux sont :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>l\u2019aspect de l\u2019ulc\u00e8re : typiquement en mall\u00e9ole interne, non n\u00e9crotique,<\/li><li>les signes cliniques associ\u00e9s : \u0153d\u00e8me de la cheville, induration, varicosit\u00e9s, varices, ecz\u00e9ma, pigmentation ocre, induration de la peau des jambes,<\/li><li>les ant\u00e9c\u00e9dents : varices, ant\u00e9c\u00e9dents de thrombose veineuse.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">L\u2019insuffisance veineuse cr\u00e9e une hyperpression veineuse \u00e0 l&rsquo;origine des ulc\u00e8res. Un \u00e9cho-Doppler veineux est indiqu\u00e9 \u00e0 la recherche d&rsquo;un reflux de sang vers le bas (incontinence de la veine) dans les veines superficielles ou profondes, qui, dans ce dernier cas correspondent le plus souvent \u00e0 des s\u00e9quelles de phl\u00e9bite.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"ulceres-arteriels\">Ulc\u00e8res art\u00e9riels<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Les arguments pour un ulc\u00e8re d&rsquo;origine art\u00e9rielle sont :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>l&rsquo;aspect de l&rsquo;ulc\u00e8re : profond, tr\u00e8s douloureux, \u00e0 bords assez r\u00e9guliers, comme taill\u00e9s \u00e0 l\u2019emporte pi\u00e8ce, \u00e0 fond sale,<\/li><li>la localisation : suspendu sur la face ant\u00e9rieure de la jambe, dos et bords externes du pied, zones d&rsquo;appui et de frottement,<\/li><li>les ant\u00e9c\u00e9dents : existence d&rsquo;une art\u00e9riopathie des membres inf\u00e9rieurs.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">La palpation des pouls, la mesure de l\u2019index de pression systolique \u00e0 la cheville (IPS) et un \u00e9cho-Doppler des art\u00e8res des membres inf\u00e9rieurs doivent au minimum \u00eatre r\u00e9alis\u00e9s pour confirmer le diagnostic d&rsquo;art\u00e9riopathie et \u00e9valuer sa s\u00e9v\u00e9rit\u00e9.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"angiodermite-necrotique\">Angiodermite n\u00e9crotique<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Ces ulc\u00e8res, survenant le plus souvent chez la personne \u00e2g\u00e9e sont caract\u00e9ris\u00e9s par l&rsquo;apparition souvent brutale, parfois \u00e0 la suite d&rsquo;un traumatisme minime, d&rsquo;une plaque fonc\u00e9e, violac\u00e9e, toujours tr\u00e8s douloureuse, extensive, qui \u00e9volue vers une plaque noire (n\u00e9crose). Une hypertension art\u00e9rielle ancienne est un facteur de risque habituel, moins souvent un diab\u00e8te. Le greffe cutan\u00e9e en pastille est tr\u00e8s efficace pour soulager la douleur et arr\u00eater l\u2019extension.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"les-embolies-de-cristaux-de-cholesterol\">Les embolies de cristaux de cholest\u00e9rol<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Des fragments de plaques de cholest\u00e9rol qui se sont d\u00e9pos\u00e9es sur la paroi des art\u00e8res migrent et occluent les art\u00e8res de petits calibres. Ces petits fragments peuvent avoir \u00e9t\u00e9 d\u00e9tach\u00e9s par un guide pass\u00e9 pour r\u00e9aliser une art\u00e9riographie ou une coronarographie par exemple. Si les fragments occlus des petits vaisseaux de la peau, la zone devient mal vascularis\u00e9e, douloureuse et prend un aspect violac\u00e9 voire n\u00e9crotique (noir) typiquement au niveau des orteils ou des talons.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Plaie chronique \u00e9voluant depuis plus de 4 semaines, situ\u00e9e entre le genou et le pied. C\u2019est une pathologie fr\u00e9quente puisqu\u2019elle concerne 2% des patients de plus de 70 ans. Elle est chronique (dur\u00e9e de cicatrisation de plus de six mois dans 40% des cas) et douloureuse dans 75% des cas. L&rsquo;ulc\u00e8re de jambe doit \u00eatre [&hellip;]<\/p>\n","protected":false},"author":25,"featured_media":0,"parent":18545,"menu_order":7,"template":"","meta":{"_acf_changed":false,"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":null,"stick-header-meta":null,"header-above-stick-meta":null,"header-main-stick-meta":null,"header-below-stick-meta":null,"astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"etablissements":[],"services":[],"class_list":["post-22623","service","type-service","status-publish","hentry"],"acf":[],"featured_img":false,"coauthors":[],"author_meta":{"author_link":"https:\/\/devhml.givememore.net\/author\/usersync\/","display_name":"usersync"},"relative_dates":{"created":"Publi\u00e9 8 ans il y a","modified":"Mis \u00e0 jour 4 ans il y a"},"absolute_dates":{"created":"Publi\u00e9 le 7 novembre 2018","modified":"Mise \u00e0 jour le 21 avril 2022"},"absolute_dates_time":{"created":"Publi\u00e9 le 7 novembre 2018 17 h 43 min","modified":"Mise \u00e0 jour le 21 avril 2022 15 h 53 min"},"featured_img_caption":"","tax_additional":{"etablissements":{"linked":[],"unlinked":[],"slug":"etablissements","name":"\u00c9tablissements"},"services":{"linked":[],"unlinked":[],"slug":"services","name":"Services"}},"series_order":"","_links":{"self":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/22623","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service"}],"about":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/types\/service"}],"version-history":[{"count":1,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/22623\/revisions"}],"predecessor-version":[{"id":22635,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/22623\/revisions\/22635"}],"up":[{"embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/18545"}],"wp:attachment":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/media?parent=22623"}],"wp:term":[{"taxonomy":"etablissements","embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/etablissements?post=22623"},{"taxonomy":"services","embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/services?post=22623"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}