What to Do About Non-Healing Ulcers

One of the complications of PAD (Peripheral Arterial Disease) is the progression of chronic limb-threatening ischemia (CLTI). This condition presents with pain while resting, gangrene, and non-healing wounds in the lower extremities. If you have wounds that do not heal, the skin will be thin, glossy, and hairless in appearance. The reason that the wounds are not healing and have such a frail disposition is due to arterial insufficiency.

If your blood supply becomes clogged with plaque, there will be less oxygenated blood flow to the affected areas. If your lower extremities are denied an adequate amount of nutrients, it will bring about ischemia, which can result in tissue death and amputation. This leaves patients severely disabled and robbed of quality of life. If left untreated, CLTI can result in death. 

If you have a non-healing wound, rest pain, or gangrene, it is of the utmost importance that you get referred to a vascular surgeon immediately. PAD can lead to the slow development of dry gangrene. The lack of blood and oxygen will also result in tissue death. As gangrene progresses, it may appear as brown, purplish-blue, or black discoloration, commonly in the feet or toes. In addition, the skin will become tremendously dry, cold, and without sensation. There may also be a foul-smelling discharge emanating from the wound.

A vascular surgeon will assess if the cause of the non-healing or gangrenous wound is due to a lack of blood supply. This assessment is done through a variety of minimally invasive tests, such as the ankle-brachial index test, an ultrasound, angiography, or blood tests. Most important is a physical examination by an experienced vascular surgeon. 

After you have been thoroughly assessed, a vascular surgeon may be able to save your limbs or heal wounds through revascularization, which is typically accomplished through such surgeries as a vascular bypass or angioplasty. Depending on the severity of the CLTI, a vascular surgeon can use medications, endovascular treatments, or an arterial surgical intervention. 

Non-healing wounds would typically be characterized as wounds that do not resolve within 5 to 8 weeks despite medical interventions. When this occurs, vascular surgery is a key component in trying to prevent devastating outcomes that can result in limb loss or serious complications. 

Types of non-healing wounds are as follows:

• Venous stasis ulcer

• Arterial ischemic ulcers

• Diabetic ulcers

• Traumatic wounds

• Pressure ulcers

Among pressure ulcers, heel ulcers are notoriously one of the most difficult to heal. Aggravating factors like being on bed restriction or being a patient with PAD, along with other comorbidities, can mitigate a successful and timely recovery. Under these type of scenarios, intervention of an excellent vascular surgeon is most critical to try to ensure the best possible outcome. 

According to a study published in the Kobe Journal of Medicine, “Nearly three-quarters of the patients with heel pressure ulcer had PAD. The wound healing rate of the heel ulcer was as low as approximately 30%, and the wound healing rate was further reduced in patients with PAD.” 

The study concludes that, “Revascularization in the cases of PAD is important for wound healing and it is also important to check for decreased blood flow during treatment.”

Since the healing rate for patients with PAD and heel pressure ulcers is so dismal, it is absolutely critical to have a patient’s blood flow examined and, if indicated, enact vascular surgery interventions. It is vital to diligently monitor and treat ulcers promptly. Utilizing a multidisciplinary approach from an early onset can prevent grave complications and may prevent amputations and infections. 

If you have PAD and develop a heel pressure ulcer, the clock starts ticking. Being proactive and taking a multidisciplinary approach that includes an expert vascular surgeon will produce the most effective solution. 

Some patients who have not been diagnosed with PAD but present with a heel pressure ulcer require a prompt evaluation for PAD. Knowing whether a patient with a non-healing wound has PAD is imperative when customizing a medical treatment plan that will promote the best possible result.

If you have a non-healing wound, rest pain, or gangrene, schedule an appointment with a specialized vascular surgeon, like Dr. David Nabi, at NewportVascular.com. Dr. Nabi performs diagnostic studies at his accredited vascular laboratory to determine the most successful pathway to save limbs and revascularize affected extremities.

The good news is that non-healing wounds can be remedied, but you need to be treated as soon as possible by a vascular surgeon who specializes in PAD and CLTI.