Introduction: The etiology of Terminal Skin Ulcers remains a mystery.
Methods: Evaluation of all constants and variables seen in patients with Terminal Skin Ulcers.
Results: We discovered that the likely reason why some people develop Terminal Skin Ulcers is due to anatomic arterial aberrations in the areas where Terminal Skin Ulcers have been described.
Discussion: Terminal skin ulcers remain an enigma in the world of wound care. Experienced clinicians can differentiate them from pressure injuries clinically. Their differentiation is critical from a medicolegal standpoint. However, the etiology of these ulcerations remains a mystery.
Clinical manifestations include Kennedy Terminal Ulcerations, “3:30 Syndrome” ulcers, and Trombley-Brennan Terminal Injuries. These have various morphologic skin changes, anatomic sites, and development speeds. Hypoperfusion is a common denominator before death. However, while everybody dies, not everybody develops terminal skin changes.
We researched all involved constants and variables and developed a hypothesis explaining this phenomenon. It is based on anatomic aberrancies of the blood vessels in the areas of the pelvis and lower extremities. Based on Poiseuille’s law, blood vessels with smaller diameters originating from an unusual anatomic site would produce a significant blood pressure drop in the affected areas at times of systemic hypotension. This results in impairment of inflow and outflow of the affected areas leading to reperfusion injury, inflammation, and tissue necrosis and causing typical morphologic skin manifestations. These arterial anatomic aberrancies are not common. Besides, there are various degrees of macro and micro variables such as the degree and duration of systemic hypotension, atherosclerotic blood vessel changes, size of the involved blood vessel branches, external pressure exerted on the vessels, development of collateral arterial supply, etc. This leads to variability in their clinical presentations.
We intend to delineate the modalities to confirm our hypothesis and request our wound care community to collaborate in resolving this phenomenon.
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