Arterial Ulcers

Holly Hovan's picture

Holly Hovan MSN, APRN, RN-BC, CWOCN-AP

Identifying wound etiology before initiating topical treatment is important. Additionally, correctly documenting wound etiology is significant in health care settings for many reasons. Accurate documentation and appropriate topical treatment are two critical components of a strong wound treatment plan and program. Bedside staff members should be comfortable with describing wounds, tissue types, and differentiating wound etiologies. Training should be provided by the certified wound care clinician, along with follow-up (chart reviews and documentation checks, one-on-one education as needed, and routine competency or education days). Additionally, the wound care clinician should be able to develop an appropriate treatment plan based on wound etiology, by involving additional disciplines as needed to best treat the whole patient.

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By the WoundSource Editors

Collateral circulation: A collateral blood vessel circuit that may be adapted or remodeled to minimize the use of occluded arteries. Collateralization may offset some of the physiological signs of peripheral artery disease, such as maintaining a normal capillary refill.

Critical limb ischemia: A severe form of peripheral arterial disease in which a severe blockage of the arteries of the lower extremities reduces blood flow. It is a chronic condition that is often characterized by wounds of the lower extremity.

Dependent rubor: A light red to dusky-red coloration that is visible when the leg is in a dependent position (such as hanging off the edge of a table) but not when it is elevated above the heart. The presence of dependent rubor is often an indicator of underlying peripheral arterial disease. When the leg is raised above the level of the heart, its color will normalize.

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By the WoundSource Editors

Lower extremity ulcers, such as venous and arterial ulcers, can be complex and costly and can cause social distress. An estimated 1% of the adult population is affected by vascular wound types, and 3.6% of those affected are older than 65 years of age. Many factors contribute to lower extremity wound chronicity, including venous disease, arterial disease, neuropathy, and less common causes of metabolic disorders, hematological disorders, and infective diseases. A total of 15% to 20% of lower limb ulcers have a mixed etiology.

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Preventing Wound Chronicity

By the WoundSource Editors

Wound chronicity is defined as any wound that is physiologically impaired due to a disruption in the wound healing cascade: 1) hemostasis, 2) inflammation, 3) proliferation, and 4) maturation/remodeling. To effectively manage chronic wounds, we must understand the normal healing process and wound bed preparation (WBP). Wound chronicity can occur due to impaired angiogenesis, innervation, or cellular migration. The presence of biofilm and infection are the most common causes of delayed healing.

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Ulcerative Wounds

By the WoundSource Editors

Ulcers in the lower extremities are more common in patients older than 65. Ulcerative wound types include venous, arterial, diabetic neuropathic, and pressure. To identify ulcer types, these wounds should be examined thoroughly for their distinct characteristics such as location and shape, as well as in conjunction with other patient information, to ensure an accurate diagnosis and treatment plan.

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Factors Contributing to Complex Wounds

By the WoundSource Editors

A vast percentage of wounds become chronically stalled because of mixed etiology and other underlying comorbid medical conditions. This means the wound is multifactorial, and using a singular approach won’t be enough. Lower extremity wounds, for example, can have diabetes, venous and arterial issues, and pressure all as factors playing into the same wound.

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Wound Chronicity

by the WoundSource Editors

Chronic wounds affect over 6.5 million people annually in the United States, with a total cost of over $26.8 billion per year. Proper identification of chronic wounds is necessary to develop an effective treatment plan, although many elements—such as intrinsic and extrinsic factors, comorbidities, and mixed etiologies—may complicate this process.

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Chronic Wounds

by the WoundSource Editors

In approaching the management of a chronic wound, the first step in developing a treatment plan that will combat chronicity and promote healthy healing of damaged tissue begins with understanding the different types of wounds.

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Cheryl Carver's picture
Heart Health

By Cheryl Carver, LPN, WCC, CWCA, CWCP, DAPWCA, FACCWS, CLTC – Wound Educator

With the millions of people living with chronic wounds, there are also millions of people living with cardiovascular disease. Every year, there are approximately 670,000 Americans diagnosed with heart disease. This equals more than one person diagnosed each minute! The skin may be the largest organ, but the heart is most vital in circulating oxygen and nutrient-rich blood throughout your body. A healthy heart is a leading factor in wound healing. Cardiovascular diseases that impede healing include peripheral arterial disease, coronary artery diseases, heart failure, and other heart and vessel issues that can inhibit blood, oxygen, and nutrition in wound healing.

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Arterial Wounds

By Martin D. Vera LVN, CWS

As we move forward in our continuation of lower extremity wounds, we will now turn our attention to arterial wounds. In my previous post, we discussed challenges with venous leg ulcers. Lower extremity wounds continue to challenge clinicians on a daily basis. We often refer to them as "the big three" – or how I like to refer to them, "the pesky triplets." It doesn't matter what we call them, we know we are referring to venous leg ulcers, arterial ulcers, and diabetic foot ulcers. In no way shape or manner will we disregard the many other types of lower extremity wounds we may encounter as wound clinicians, but these three are the most common and often present with treatment challenges.