Differential diagnosis of a skin ulcer on an amputation stump:
(1) pressure ulcer (ill-fitting limb prosthesis, abrasion with liner or sock)
(2) peripheral vascular disease (ischemia)
(3) thrombosis secondary to cryoprotein or hypercoagulable state
(4) infection
(5) vasculitis
(6) cancer
(7) chronic wound at surgical site
The workup may include:
(1) a complete history and physical, including a discussion with the patient or family about stump care
(2) biopsy of the edge of the ulcer with culture (bacterial, fungal, AFB) and histologic exam
(3) assessment of limb perfusion
(4) coagulation workup
(5) measurement of cryoglobulins and cryofibrinogen in serum
(6) evaluation for an autoimmune disease
