Lower Extremity Wounds & Ulcers
Skin disruption occurring at a site of traumatic injury is commonly referred to as a “wound”.
Ulcers are wounds or open sores that will not heal or keep returning.
When traumatic injury occurs the process of wound healing relies on a complex interplay between various body systems (cellular, immune, hematologic and metabolic processes). These complex processes can only occur when there is adequate circulation to the area of injury.
Circulation problems can inhibit the ability of the body to heal an established wound, and in some circumstances circulation problems can be the primary cause of skin breakdown (ulcer).
Peripheral arterial disease (“PAD”) refers to a condition where plaque accumulates within the wall of an artery. Plaque accumulation within an arterial wall is conceptually analogous to a pipe getting “clogged up”. Narrowings and blockages created by the plaque make it difficult for oxygen-rich blood to flow to the lower portions of the legs and feet. Oxygen is a key ingredient for wound healing.
Severe peripheral arterial disease can dramatically compromise the flow of oxygenated blood to the feet and toes. In this situation it is possible for skin breakdown (ulcers) to occur on the feet or toes, simply because there is inadequate oxygenated blood getting to these areas. This situation is often referred to as “critical limb ischemia.”
Vein problems (“venous insufficiency”) can also be the cause of ulcer formation in the legs. Structural abnormalities in the veins (such as valve dysfunction or blood clots) interfere with egress of venous blood from the leg. “Back-pressure” within the venous system (created by this impaired egress of venous blood) results in leg swelling. In turn, leg swelling compromises effective wound healing, and can be the primary pathologic process causing venous leg ulcers.
Skin ulcers caused by arterial problems typically occur on the toes or feet. Ulcers are wounds or open sores that will not heal or keep returning.
Venous ulcers are treated with compression of the leg to minimize edema or swelling. Compression treatments include wearing compression stockings, multi-layer compression wraps or dressing from the toes or foot to the area below the knee.
Arterial ulcer treatments vary, depending on the severity of the arterial disease.