P.I. is a 68-year-old Black woman who presents to the clinic…
P.I. is a 68-year-old Black woman who presents to the clinic with a painful leg wound for 2 months. P.I. is employed at the local grocery store as a cashier. On exam, you note an ulcer above the medial malleolus on the right leg. The ulcer is about 8 cm wide x 10 cm long x 0.5 cm deep with irregular borders, erythematous base, and yellow exudate. P.I. rates the pain as a 2 on a scale of 10. Additional findings include 1+ pretibial edema and brown discoloration of her lower extremities. Distal pulses are present and negative Homan’s sign. Which of the following is the most likely cause of these ulcers?