Wounds on the lower extremities (LE) are very common and have a significant effect on a patient’s health. Most often they become chronic wounds that require a great deal of care. They are costly for the public health care system as well as the patient.
Arterial ulcers often start as a break in the skin on the leg or foot. It can be caused by dry skin, an injury, or a puncture wound. For most, these injuries will heal with proper care. For those with arterial disease, the wound cannot heal due to poor blood flow. This increases the size of the wound while allowing oxygen and bacteria to enter the wound and subcutaneous tissue. Infection occurs, leading to more damage. Minor scrapes and cuts can then develop into ulcers, the tissue becomes necrotic and black.
Arterial ulcers are also known as ischemic ulcers. They occur because blood flow to the lower extremity (LE) is not adequate. This is the result of occlusion, blood clot, or decreased blood flow secondary to vascular disease, specifically, peripheral arterial disease (PAD). Tissue ischemia is extremely painful. These ulcers generally do not heal unless perfusion (blood flow) is restored. Lower extremity arterial disease (LEAD) includes diseases that affect the arteries in the legs. Most ischemic ulcers occur in the legs and are caused by LEAD. Arterial ulcers are prone to infection.
One-third of adults age 65 and older are affected by LEAD and more are undiagnosed. Damage is silent as many do not have symptoms initially. Symptoms occur once the disease process is advanced. With the advancement of the disease, the risk for morbidity (how sick) and mortality (death) increases.
As mentioned previously, many are asymptomatic until advanced stages. Once symptoms occur, they include:
These symptoms are often overlooked because they are thought to be associated with aging, musculoskeletal conditions or a sedentary lifestyle.
Some risk factors for PAD are modifiable (those in your control) while others are hereditary or cannot be changed. Factors you can control include:
Some predisposing risk factors are modifiable while others are not. That modifiable include:
Risk factors that are not modifiable include:
The primary treatment is to improve perfusion, increase blood flow to the LE. Risk factors that are modifiable should be addressed aggressively to prevent the progression of the disease. Revascularization can include surgical procedures such as bypass graft (most common) and endovascular procedures such as angioplasty and stent placement.
Topical treatments for arterial ulcers are much like other wounds. Debridement of necrotic tissue and management of bacteria is the first step. Maintaining a moist environment for healing is important. Ischemic ulcers most often are dry with minimal drainage. There is a high risk for infection. It Is best to use a topical treatment with sustained-release antimicrobial properties (Silvasorb Gel by Medline) along with a moisture retentive dressing. It is recommended to use a non-adherent dressing such as a silicone adhesive Allevyn Life Foam Dressing by Smith & Nephew because the skin surrounding the wound is usually very fragile.
If the wound is ischemic, showing no signs of infection and the surface is dry and necrotic, moisture should not be added. Povidone-iodine 10% swab sticks by Medline can be applied to the wound. Once dry, cover the wound with a dry dressing such as Kerlex made by Covidien or Medline.
For those with known arterial disease, prevention is important. Here are some things you can do.
Author Profile: Christine Kijek, Registered Colorectal Nurse
Disclaimer: All content found on our website, including images, videos, infographics and text were created solely for informational purposes. Our content should never be used for the purpose of diagnosis or treatment of any medical conditions. Content shared on our websites is not meant to be used as a substitute for advice from a certified medical professional. Reliance on the information provided on our website as a basis for patient treatment is solely at your own risk. We urge all our customers to always consult a physician or a certified medical professional before trying or using a new medical product.
When traditional oral intake is not feasible, enteral feeding comes into play. It supports nutritional needs of individuals recovering from an injury or surgery. Dive into this informative article and learn what, when, why, and how of enteral feeding and ensure optimal patient care.
Looking for a non-invasive option to manage carpal tunnel symptoms? Experience relief from constant tingling and pain with this Carpal Solution Wrist Support. Read this article to know about the unique features and benefits of this wrist support brace designed to deal with CTS and find why it is one of the most reliable wrist braces available on the market.
Need an effective and affordable nebulizer? Look no further, in this article we offer 5 of our best reviewed nebulizers that are loved by our customers. Click to read more and find the perfect nebulizer for all your respiratory needs.
Worried about nighttime leaks? Say goodbye to leakage with our ten best overnight adult diapers and wake up refreshed and dry.
Neck pain can wreak havoc on your otherwise healthy life. Traction device improves your cervical health and overall well-being. Read more to find our best cervical traction devices designed to curb the stiffness and discomfort of cervical muscles.