Peripheral Vascular Disease

By Aletha Tippett MD This week I saw a patient with terminal peripheral vascular disease (PVD). Seeing him reminded me of how often the severity of this disease is misunderstood. He had had amputation of the toes on his right foot due to gangrene. The toes on his left foot had early gangrenous changes, similar to what had happened on his right. Of course, amputation of the toes did not solve his problem, it just moved the gangrene up further. He now has a gangrenous wound at the amputation site. Also, he has a new gangrenous round ulcer on his lateral foot. This came from tape which had been used to fasten a dressing to his foot.

Vascular ulcers are wounds on the skin that form as the result of abnormal blood circulation in the body, including arterial and venous etiologies. Estimates suggest 3-5% of those over 65 in the United States have a vascular ulcer.

By Aletha Tippett, MD I was recently talking to a young nursing student who told me she had had a terrible week and cried when she had to do wound care for a patient. When asked what the problem was she reported that her patient was an elderly man near death who had severe peripheral vascular disease with gangrene on both feet. He had severe pain whenever touched and she was instructed to wrap his legs with gauze and ace wraps.