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Arterial Leg Ulcer

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Where a problem with arterial circulation is suspected, patients should be referred to a Vascular Surgeon for assessment. Arterial ulcers are caused by insufficient arterial perfusion to the lower extremities. Disease often results from arteriosclerosis of vessel walls and atherosclerotic plaque accumulation causing vessel occlusion.

Peripheral vascular disease associated with arterial insufficiency may result in limb tissue ischaemia. Disease is usually progressive and may affect only one limb unless diabetes is also a factor, which can result in bilateral involvement. Gradually the limb shows evidence of longstanding ischaemia: the skin becomes thin with loss of hair, subcutaneous tissue and muscles atrophy, nails become thickened, limb colour and temperature change becoming pale and cool, pulses become difficult to palpate and pain increases with exercise (known as intermittent claudication) or limb elevation. Accidental trauma to the ischaemic limb can result in formation of a difficult to heal ulcer.

In severe ischaemia, healing may not be possible and the goal becomes prevention of infection and the delay of potential amputation. Management is complex and is best accomplished by an interdisciplinary team approach¹.

Consistent, conscientious care is essential to encourage and support the patient to adopt and maintain healthy lifestyle changes which improve tissue perfusion. Patients may become discouraged if pain is uncontrolled or if healing is slow or absent².

For more information see:

1. Richardson J, Prentice D, Rivers S (2001) Clinical management extra: skin care pathway. Developing an interdisciplinary evidence-based skin care pathway for long term care. Advances in Skin & Wound Care 14(4): 197-205.
2. Rook JL (1997) Wound care pain management. Nurse Practitioner: Am J of Primary Health Care 22(3): 122-131

Information provided with support from the Wound Healing Research Unit, Cardiff.

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