Physical examination should include wound assessment, pulses, leg circumferential measurements, sensation, mobility and blood work. Common diagnostic tests may include ABI, duplex ultrasound, angiography, MRI and or/skin biopsy(1). Surgical procedures may be required for some people with a goal to restore blood flow and remove necrotic tissue for wound healing.
Arterial wounds are ischemic ulcers due to a lack of blood flow to the area. They can be further exacerbated by smoking, intermittent claudication, and medications that promote vasoconstriction. Arterial wounds will normally present on the distal or dorsum of the foot or toes, over bony prominences normally they will have poor granulation tissue, a round punched-out appearance and fairly dry necrotic tissue. Pain can be severe, particularly at night; relieved by lowering feet below the heart(1).
Lower extremity ulcers can be complicated by mixed etiologies which complicate treatment and prolong healing. People can have multiple medical issues that can worsen lower extremity ulcers. For instance, diabetes may lead to foot ulcers, lymphedema frequently coincides with open areas on the legs, cellulitis can affect any open area. Many patients with lower extremity ulcers suffer from debilitating pain, recurrent infection, impaired work productivity and eventually poor quality of life (4).
By Dr. Heather Flexer, DPT, CWS
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