Stitching together a correct diagnosis
Peripheral vascular disease – its effects cause hardship to over three million people every year. And while its effects can vary from patient to patient, the undeniable truth is that a multitude of PVD’s effects can cause both serious cosmetic and health concerns for the affected person. Among these effects are ulcers on the arms, legs and feet, developed as a result of poor blood flow that promotes insufficient healing in the afflicted areas.
Through the various forms of peripheral vascular disease, patients who experience these diseases can often develop non-healing wounds in their extremities as a result. These ulcers can be brought on by a variety of risk factors, which contribute to the development of these wounds. The risk factors include, but are not limited to:
Advanced stage of peripheral artery disease
Inflammatory disease, such as vasculitis, lupus or scleroderma
While these wounds may cause discomfort or show a displeasing appearance if left untreated, there are a variety of treatment options for ulcers. However, in order to provide the proper treatment, it is important to first locate and diagnose the ulcer correctly. Because of that, here are the three main types of wounds, and their differences.
1. Venous Stasis Ulcers
Caused by poor circulation from the legs, such as from venous insufficiency, venous stasis ulcers are developed when the one-way valves that keep blood flowing toward the heart are damaged and pools of backed up blood form in the vein. As a result, the vein and surrounding tissue may leak fluid, leading to the breakdown of the tissue, and a subsequent ulcer. Deep vein thrombosis, obesity, smoking and a lack of physical activity are some of the leading contributors to venous stasis ulcers. Typically, these ulcers are found on the inner part of the leg, below the knee and just above the ankle. When attempting to locate these ulcers, be on the lookout for yellowish tissue and possible drainage.
2. Neurotrophic Ulcers
Also commonly referred to as “diabetic neuropathic ulcers,” these ulcers occur in people with diabetic nerve damage, with no or little sensation in their feet. People with increased pressure points on the bottom of their feet are at a higher risk for these ulcers, but these ulcers can appear anywhere on the foot. Many patients who suffer from neurotrophic ulcers often complain of numbness, tingling or burning of the feet, and can be associated with cellulitis, lymphangitis, adenopathy, foul odor and purulent drainage. Their appearance is often defined by a pinkish red or brownish/black base, with punched out borders and calloused surrounding skin.
3. Arterial Ulcers
Less common than venous skin ulcers, arterial skin ulcers are often tremendously painful, and happen when artery disease is present. Typically found at the heels, toes or nail bed, the surrounding skin of arterial ulcers is often red and swollen, punched out borders and either yellow, brown, grey or black coloration. The skin may also be shiny, cool or smooth, with a dry, dark base, and have the potential to include gangrene as well.
There are a variety of options for treating ulcers, and can be found below.
- Antibiotics – Usually found in topical or oral form, antibiotics can be used to treat an infection in a wound if present.
- Compression dressings – Generally used venous stasis ulcers, compression dressings can help minimize swelling of wounds, and involves wrapping an ACE bandage around the wound, or a series of multi-layer compression wraps.
- Debridement – The number of substances and microbes that inhibit healing are reduced during debridement, when the dead or infected tissue of the wound is removed.
- Prosthetics/orthotics – In order to help restore someone back to their normal level of functioning, prosthetics or orthotics can be implemented and worn.
- Skin grafts – This procedure can help restore a more normal appearance to the wound, or faster healing – by removing healthy skin from one part of the body, or synthetic material, to the afflicted area.
- Topical wound care therapies – These therapies are numerous in number, and can help to aid wounds on the skin. These treatments can include, but are not limited to: Alginate, antimicrobial dressings, collagen wound dressings, composite dressings, hydrogels and hydrocolloids.