腿部（膝盖以下）的慢性伤口称为腿部溃疡。造成腿部溃疡的原因有很多，因此腿部溃疡患者需要接受许多不同类型的医疗专家的治疗。大约 80% 的患者患有慢性静脉功能不全 (CVI) 和/或外周动脉闭塞性疾病 (PAOD)。了解相关的鉴别诊断对于适当的治疗非常重要，特别是对于具有不典型表现或顽固病程的患者。本文基于 PubMed 选择性检索检索到的出版物，包括当前指南和专家建议。腿部的诊断评估溃疡可以根据ABCDE规则来构造。这涉及个性化、有针对性的病史采集（既往史）；细菌学检测；临床检查；辅助测试，特别是灌注（有缺陷的血管系统）；以及额外的内容，例如活检。具体来说，我们在本文中介绍了腿部静脉溃疡、腿部动脉溃疡、血管炎、血管病变、钙防御、坏疽性脓皮病、类脂坏死、臁疮和鳞状细胞癌的复杂诊断评估的主要方面。仍然存在许多未解决的问题，包括临床治疗各个领域之间的相互作用以及相关高质量研究的相对缺乏。对许多可导致腿部溃疡的疾病进行及时的鉴别诊断评估，需要许多不同领域的代表进行治疗医学专业和健康专业，是其有效的个体化治疗的先决条件。

Chronic wounds on the leg (below the knee) are called leg ulcers. They have many causes, and thus patients with leg ulcers are treated by many different kinds of medical specialist. Appproximately 80% of sufferers have chronic venous insufficiency (CVI) and/or peripheral arterial occlusive disease (PAOD). Knowledge of the relevant differential diagnoses is important for appropriate treatment, particularly for patients with atypical findings or an intractable course.This article is based on publications retrieved by a selective search in PubMed, including current guidelines and expert recommendations.The diagnostic evaluation of a leg ulcer can be structured according to the ABCDE rule. This involves individualized, targeted history-taking (anamnesis); bacteriological testing; clinical examination; ancillary testing, particularly for perfusion (defective vascular system); and extras, such as biopsies. Specifically, we present in this article the main aspects of the complex diagnostic evaluation of venous leg ulcers, arterial leg ulcers, vasculitis, vasculopathy, calciphylaxis, pyoderma gangrenosum, necrobiosis lipoidica, ecthyma, and squamous cell carcinoma. There remain many unsolved problems, including interactions between the various areas of clinical treatment and the relative paucity of relevant high-quality research.A timely differential-diagnostic evaluation for the many diseases that can cause leg ulcers, which require treatment from representatives of many different medical specialties and health professions, is a prerequisite for their effective individualized treatment.