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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 ischemia.
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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