A 44-year-old Hispanic man presented with a 25-year history of chronic nonhealing ulcers in the upper and lower extremities and in both hands. The patient's ulcerations continued to worsen over time, despite the use of antibiotics and good local wound care. He then developed lower-extremity gangrene and generalized leg pain with walking, which eventually necessitated several surgical approaches, including amputation below the knee on the right leg and above the knee on the left leg and a sympathectomy on the right leg.
Zellerman GL, Lin MTS, Orengo I, Rosen T. Chronic Ulcerations in the Upper and Lower Extremities. Arch Dermatol. 1998;134(8):1019-1024. doi: