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- Optimize perfusion. Refer for surgical evaluation and consideration of possible revascularization.
- Support moist wound healing. If perfusion is poor, the wound bed may dry out quickly. If the patient with an arterial ulcer is not a surgical candidate, cautious use of moisture-retentive dressings, keeping dry wounds dry, and close monitoring are important.
- Prevent, treat, and observe for signs of infection. Consult with physician to determine the need for antibiotic therapy, debridement, cleansing, and dressing approach. If gangrene is present, keep the wound dry to avoid further bacterial growth. Wounds located between the toes may benefit from cotton or sheepskin placed between the toes to absorb fluid and protect skin. Following revascularisation, moist wound healing techniques may be resumed.
- Ambulate as tolerated.
- Control oedema, if present.
- Debride when indicated. Method selected is based upon the condition of the patient and wound. Debridement may be contraindicated in arterial wounds. Methods of debridement include autolytic, mechanical, sharp, and enzymatic.
- Perform daily skin inspection and care. This may include cleansing, moisturizing, and protective barriers.
- Provide adequate nutritional intake.
- Manage pain.
- Provide education to patient, family, and caregiver. Topics include smoking cessation, compliance with medications, control of diabetes, avoidance of exposure to friction or trauma, avoidance of extreme temperatures on skin, limitation of constrictive clothing, leg crossing, and going barefoot, proper footwear and nail care, positioning to control pain, close follow-up with care providers.
- Document assessments and interventions.
- Reassess at regular intervals per agency protocol.
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