Arterial ulcers

Arterial wounds, also known as arterial ulcers, are painful injuries in your skin caused by poor circulation. ‌

Arterial ulcers typically happen when blood is unable to flow into the lower extremities, like the legs and feet. When the skin and underlying tissue are deprived of oxygen, the tissue starts to die off and form an open wound. 

Impact of Arterial Wounds on Your Health

Arterial wounds tend to be extremely painful and uncomfortable. ‌

Due to poor circulation, arterial wounds may heal slowly. The lack of circulation can also make it difficult for the red blood cells to deliver the nutrients needed to heal. Without oxygen-rich blood, white blood cells may not be able to fight off bacteria, making the wound more likely to become infected.‌‌

If left untreated, arterial ulcers can lead to more serious diseases or complications, including infection, tissue necrosis, and, in extreme cases, amputation.

Symptoms of Arterial Ulcers

Arterial ulcers are characterized by a punched-out look, usually round in shape, with well-defined, even wound margins. Arterial ulcers are often found between or on the tips of the toes, on the heels, on the outer ankle, or where there is pressure from walking or footwear. The wounds themselves are characteristically deep, often extending down to the underlying tendons, and will frequently display no signs of new tissue growth. The base of the wound typically does not bleed, and is yellow, brown, grey or black in color.

Often the limb will feel cool or cold to the touch, and the extremity will have little to no distinguishable pulse. The skin and the nails on the extremity will also appear atrophic, with hair loss on the affected extremity, while also taking on a shiny, thin, dry, and taut appearance. In addition, the base color of the extremity may turn red when dangled and pale when elevated. An additional sign of an arterial ulcer is delayed capillary return in the affected extremity.

These ulcers are generally very painful, especially while exercising, at rest, or during the night. A common source of temporary relief from this pain is dangling the affected legs over the edge of bed, allowing gravity to aid blood flow to the ulcerous region.

Arterial ulcers are distinguishable from venous ulcers in that venous ulcers present with redness and edema (swelling) at the site of the ulcer, and may be painless.

Arterial ulcers

Arterial ulcers often form on the outer side of the ankle, feet, heels, or toes. They can form in other areas, too. These ulcers are painful and have a “punched out” appearance.

Other symptoms or characteristics of arterial ulcers include:

• red, yellow, or black sores
• deep wound
• tight, hairless skin
• leg pain at night
• no bleeding
• affected area is cool or cold to touch from minimal blood circulation
• leg reddens when dangled and turns pale when elevated

Venous ulcers

Venous ulcers usually form below the knee and on the inner area of the ankle. There’s sometimes little or no discomfort, unless the ulcer is infected. In other cases, venous ulcers can be painful.

The affected area may also be accompanied by the following symptoms:

• inflammation
• swelling
• aching
• itchy, hardened skin
• scabbing or flaking
• brown or black stained skin
• discharge

causes

Arterial ulcers are caused by arterial insufficiency; that is, inadequate delivery of oxygen and nutrient-rich blood to the tissues. Arterial insufficiency is caused by high blood pressure and narrowing of the arteries due to atherosclerosis. Atherosclerosis is due to deposits of circulating lipids at the sites of damaged vessel walls as a result of the effects of smoking and high blood pressure. These deposits partially occlude the artery, resulting in reduced blood flow to tissues.  

Most often, an arterial ulcer develops following a minor injury that is slow to heal due to the poor blood supply to the wound.

In severe arterial disease, spontaneous cell death may cause skin breakdown without a precipitating injury.

Alternatively, cholesterol deposits lining the blood vessel walls may break off and become lodged in smaller vessels downstream, causing a sudden and complete blockage in flow; this process is called embolic occlusion.

Treatment of Arterial Ulcers

The following precautions can help minimize the risk of developing arterial ulcers in at-risk patients and to minimize complications in patients already exhibiting symptoms:

• Examine feet (especially between the toes) and legs daily for any unusual changes in color or the development of sores.
• Quit smoking. Smoking can harden or clog the arteries, leading to improper perfusion to the extremities.
• Manage blood pressure, cholesterol, triglyceride and glucose levels.
• Ensure that footwear is properly fitted to avoid points of rubbing or pressure. Avoid wearing constrictive socks.
• Avoid crossing legs while sitting.
• Avoid sitting or standing for extended periods.
• Avoid cold temperature.
• Protect legs and feet from injury and infection.
• Exercise as frequently as is comfortable.

The primary goal of the treatment of arterial ulcers is to increase circulation to the area, either surgically or medically. Surgical options range from revascularization in order to restore normal blood flow to amputation and rehabilitation in patients who cannot be revascularized. As for non-surgical measures, modifying contributing factors can slow or stop the progression of the local ischemia. Additionally, there are boots and pumps available to augment perfusion to the affected limb.

The ischemic wounds themselves differ from other severe wounds in that the wound environment should be as dry as possible to decrease the risk of infection. The use of cadexomer iodine around the wound margins is an option due to its absorptive properties. This polymer draws exudate and particulate matter from the wound, then when moist releases iodine, serving the dual purpose of cleansing the wound and fighting bacteria at the wound site. Topical antibiotic ointments, such as bacitracin and triple antibiotic, should be used sparingly as they can actually be toxic to cells.