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Lower Extremity Wounds & Ulcers

Skin disruption occurring at a site of traumatic injury is commonly referred to as a “wound”.
Skin breakdown wthout preceding injury is known as an “ulcer”.

Overview

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.

Symptoms
Any area of unexpected skin breakdown on the legs can be a sign underlying problems involving the arteries or veins. Click to learn more
Diagnostic Workup
The diagnostic work-up for underlying vascular disease is guided by symptoms, and physical examination finding. Click to learn more
Treatment
Effective treatment of leg wounds requires diligent identification and treatment underlying vascular disorders. Click to learn more