Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

They’re less frequent than diabetic ulcers, but how concerned should we be about arterial ulcers (ischemic ulcers)?

Atherosclerosis is the major cause of peripheral arterial disease. This reduces the arterial blood flow to the lower extremities. The lumen of the arteries become occluded and the extremity becomes ischemic. Most ulcers develop due to a traumatic event to the ischemic leg or foot. However, skin breakdown can occur spontaneously. 

Risk factors for arterial ulcers include hyperlipidemia, smoking, hypertension, diabetes, advanced age and post trauma to the foot or leg.

Arterial ulcers are usually located on the top of the toes, over the phalangeal heads, around the lateral malleolus, or areas subjected to trauma. Many times they are associated with incorrect fitting footwear. Skin may appear as thin, cool, hairless and shiny with a grayish, dark red color. Dorsalis and posterior pulses are usually decreased or absent.

The wound characteristics include even wound margins, punched out appearance with demarcated edges, wound bed is deep and pale in color, blanched peri-wound tissue and pain. There also may be cellulitis, minimal exudate, necrotic tissue and possible gangrene.

Based on the resident’s condition and the physician’s treatment plan, a surgical procedure to re-establish arterial blood flow may be performed. Supplementary interventions include blood sugar control, measures to reduce hyperlipidemia, programs to assist the resident to discontinue smoking, and assistance to ambulate as the resident tolerates. If surgery or procedures to increase blood flow to the extremity are not possible, amputation of the extremity may be the only option. Supportive wound care includes moist wound healing.