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| Arterial ulcers result from chronic or acute arterial insufficiency to the skin and subcutaneous tissue of the lower extremities. The most common cause is a progressive disease: atherosclerosis. The precipitating event leading to ulceration is usually trauma, such as a bumped toe or tight shoes. Arterial ulcers may occur alone or in combination with diabetes, venous stasis, and numerous other conditions. |
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| The ulcer may be amenable to healing with topical therapies depending upon the degree of ischaemia. Pharmacological treatment may include thrombolytic therapy or drugs aimed at increasing the supply of oxygenated blood to the area. However, the primary approach to treatment is revascularization. Therefore, a surgical referral is indicated in these patients. |
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Arterial leg/foot ulcers typically share the following characteristics:
- Located most often on the tips of the toes, web spaces, or proximal to the lateral malleolus of the foot
- Round, small, pale wound base; necrosis or eschar may be present; depth varies
- Wound margins have a punched appearance
- Small to moderate amounts of wound exudate
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| The ulcer is staged as partial-or full-thickness. Partial-thickness ulcers involve the epidermis and dermis, whereas full-thickness ulcers extend into deeper tissue which may involve subcutaneous tissue, muscle, bone, or other supporting structures. |
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The skin of the periwound, leg, and foot area may have evidence of the following changes:
- Shiny, taut, thin appearance
- Erythema
- Dry and without hair
- Cool skin temperature
- Indurated area around wound
- Cellulitis
- Dependent rubor and pallor on elevation
- Diminished or absent pulses
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| Multidisciplinary management of these patients with early intervention and close monitoring is key to prevention of more serious complications. Improper management of complications such as gangrene and osteomyelitis may result in amputation. |
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