Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In his discussion of the physical
examination of pressure ulcers, Dr Lyder1 did
not discuss palpation of pulses and assessment of circulation. Often the first
sign of globally insufficient circulation to a foot is the loss of ability
of the tissue to repair following minor trauma.2 The
main factor behind this inability to repair is macroscopic vascular occlusive
disease, meaning occlusion of large arteries, rather than microvascular disease.
Although diabetes mellitus is the most common risk factor because of tibial
artery atherosclerosis, a similar mechanism can lead to tissue loss in the
presence of connective tissue disorders.2 Debridement
of necrotic tissue is indicated for pressure sores, except when ischemia is
manifested. An ischemic extremity must be revascularized to restore its ability
Kaufman JL. Management of Pressure UlcersManagement of Pressure Ulcers. JAMA. 2003;289(17):2209-2211. doi:10.1001/jama.289.17.2209-a