Write a 8 pages paper on ischemic ulcer in a diabetic patient. Other important findings in the history include the presence of intermittent claudication of the left lower limb for one year. John is a

Write a 8 pages paper on ischemic ulcer in a diabetic patient. Other important findings in the history include the presence of intermittent claudication of the left lower limb for one year. John is a chronic smoker. He decreased smoking since one year after the onset of claudication symptoms, following advice from a physician. However, he has not been able to completely quit smoking. During the current visit to the hospital, there is no history of fever or any other symptoms. The patient complains that the onset of ulcer started after he began to wear new slip-on shoes with a narrow toe box. The patient reported being allergic to penicillin. There is no history suggestive of occupational injury, trauma, varicose veins, previous history of lower limb wounds/ulcers/gangrene, history of amputations and history of any other surgeries. There is no family history of similar ulcers either. The patient is not suffering from any collagen diseases. He is not on any anti-inflammatory drugs or steroids.The condition of the patient is stable. He is afebrile. He looks well nourished. Vitals signs are stable. A systemic examination is within normal limits. The ulcer is located over the lateral malleolus of the left leg. The size of the ulcer is 3cm in length, 2 cm in width and about 0.5 cm in depth. The borders are regular and the wound appears punched out and clean. The color of the ulcer is yellowish. There is minimal granulation tissue. The exudate from the ulcer is mainly serious and minimal. The surrounding skin appears pale, non-edematous, shiny and has decreased hair. Dorsalis pedis pulsation appears normal.Lower extremity ulcers are very common in patients with diabetes and in fact, these are the most common causes for limb amputation in diabetic population (Armstrong and Lavery, 1998). Factors which contribute to the development of ulcers in the diabetic population are diabetic neuropathy, peripheral arterial disease and structural deformity (Armstrong and Lavery, 1998).&nbsp.&nbsp.

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