People who are suffering from diabetes or other problems such as critical limb ischemia leading to poor blood circulation are at higher risks of developing lower extremity wounds on their legs or feet. For example, Diabetic Ulcers, Arterial or Venous Ulcers, etc. These types of wounds do not heal within a standard period and require extra wound care & treatment by Wound Care Experts.
Effective treatment is focused on removing barriers so that quicker wound healing can be ensured depending on the patient’s individual needs. Before starting the treatment, the patient & the wound must be evaluated properly and a treatment plan is generated.
This blog covers major three types of lower extremity wounds i.e. Venous, Arterial & Diabetic Ulcers along with their symptoms, steps in the evaluation & treatment to make sure that the patients receive the right care at the right time, to promote wound healing, prevent potential infections, avoid multiple hospital visits & possibility of amputation for these types of wounds. Let’s start:
Types of Lower Extremity Wounds
Venous Ulcers
Venous ulcers are leg ulcers caused by poor blood circulation in leg veins. Also known as venous stasis ulcers or non-healing wounds, when the leg veins fail to deliver blood back toward the heart due to a condition called Venous Insufficiency, it causes the development of venous ulcers. The blood creates pressure and excess fluid in the affected area can cause the formation of an open wound. The risks of venous ulcers increase with age.
Symptoms
A venous ulcer commonly occurs on the lower leg or ankle with well-defined borders. The surrounding skin may be shiny, tight, warm or hot, and discolored. If the sore is infected, it may have a bad odor with draining pus from the wound.
Here are the warning signs of venous ulcers:
- Leg swelling, and cramping
- Itching and tingling
- Red-colored skin on the legs
- Swollen veins etc
Evaluation
- The clinical assessment by Bedside wound care experts should be focused on risk factors such as previous venous disease ie. any family history, or trauma, DVT, pregnancies, heart failure, heavyweight and increased age.
- Additionally, surgeons are also required to document the time when symptoms were noticed by the patients, and treatment received with associated symptoms.
- The physical examination includes assessing the patient’s nutritional status & lower legs. Ask for any allergies, hyperpigmentation, firm edema, chronic diseases (especially arterial disease or diabetes), infections, and thin skin, etc.
Diagnostic Tests
The following tests will help doctors understand treatment better:
- Ankle-brachial index (ABI)
- Contrast venogram
- Doppler ultrasonography
- Radionuclide venography etc.
Patient Treatment Goals
- Healing the ulcer & managing the associated symptoms to prevent ulcer recurrence
- Treating underlying venous insufficiency along with any protein & vitamin deficiencies.
- Wound debridement is required.
- Use a moisture-retentive dressing depending on the size of the wound, presence of infection, and amount of exudate.
- Leg elevation or compression therapy
Arterial Ulcers
Also known as ischemic ulcers, arterial ulcers are caused by poor arterial blood flow. In simple words, when the arteries which carry nutrient- and oxygen-rich blood to the various tissues in the body fail to deliver blood to the lower extremities, it causes the development of an arterial ulcer. It further leads lack of oxygen to the overlying skin & tissues, killing them and causing the formation of an open wound.
Symptoms
Here are the warning signs of arterial ulcers:
- A punched-out look, usually round in shape with well-defined wound margins.
- Legs feel numb and cool to touch.
- Pain, fatigue, or discomfort in the muscles of the feet.
- Cramps and thick toenails.
- Hair loss on the legs etc.
Evaluation
- The Wound Care Specialist should ask for the patient's history and note down the possible risk factors for atherosclerosis including age over 50, smoking habits, diabetes, or any family history of atherosclerosis, etc.
- Leg assessment of the patients includes surrounding skin conditions such as pale, cool, thin or hairless, etc.
- Presence of wet or dry gangrene.
Diagnostic Tests
The following tests will help doctors understand treatment better:
- ABI
- Segmental leg pressures
- Transcutaneous oximetry
- Lower extremity arteriography
- Magnetic resonance angiography (MRA) etc.
Patient Treatment Goals
- The common goals include improving blood circulation, wound debridement, and treating pain.
- Use of occlusive dressing to prevent further infection, control exudate, reduce pain and ensure a moist healing environment.
- Surgical or percutaneous intervention may be required.
- Instruct patients about life changes to improve their health such as controlling cholesterol & blood pressure, and quitting smoking, etc.
Diabetic Foot Ulcers
A patient suffering from peripheral neuropathy related to diabetes may find it difficult to notice foot problems until an ulcer develops. Diabetes increases the risk of developing a sore or an open wound on the skin. These ulcers generally form on the bottom of the foot and can affect other areas also such as legs, hands, or around the stomach.
Symptoms
Here are the following symptoms of a diabetic ulcer:
- Red, dry or cracked skin on feet and toes.
- Red spot or callous on the feet.
- Signs of infection etc. like pain, fever, or chills.
Evaluation
- Ask the patient history and instruct them on self-care techniques such as reviewing feet and between the toes.
- Evaluate neuropathic and ischemic foot symptoms with wound history.
- Conduct a vascular examination and assess the patient's feet & toes for any skin breakdown or ulcer.
- Confirm any ulcer-related pain etc.
- Use a screening device to determine foot sensation.
Patient Treatment Goals
- The common goals for wound care at Bedside include promoting wound closure, maintaining a moist wound environment, eliminating pressure on the foot, and improving muscle strength in the legs.
- Topical management relies on the size of the wound, exudate amount, and presence of an infection.
Self-care Techniques For Patients
- In addition to this, the patients should maintain a protein and fluid-rich diet to promote healing.
- Inform the doctor if you notice an open wound on your legs or feet especially if you have risk factors such as poor blood circulation.
- Evaluate the skin regularly for an open wound if risk factors are present such as heart or kidney diseases, smoking habits, obesity, lack of mobility, etc.
- Follow the treatment carefully.
- Exercise daily & quit smoking.
Regardless of the type of lower extremity wounds, full & consistent wound information is necessary to be adopted by the Wound Care Surgeons. Always conduct proper documentation including wound size, appearance, location, and condition of the surrounding skin, etc.
