Ischemic Wounds

Ischemic wounds occur as a direct result of blocked blood flow to medium and small vascular beds in the body. This condition is called arterial insufficiency. Ischemic wounds are often found on the legs, feet and toes – typically on shins, heels, tops or sides of feet, tips of toes or between the toes where the skin rubs together.

Causes

When blood flow is blocked from an area of the body, that tissue is deprived of vital nutrients, causing damage and death at a cellular level. Damaged tissue deprived of adequate blood flow has a decreased ability to heal. A primary cause of blocked blood flow is atherosclerosis – a condition in which artery walls thicken and become less flexible. Atherosclerosis is the most common cause of ischemic wounds, although other conditions such as inflammation or excessive fluid build up also cause these wounds.  Additionally, individuals with arterial insufficiency often have other medical conditions that contribute to decreased sensation, particularly in the lower limbs. The inability to feel painful sensations (such as a shoe rubbing against the side of a foot) coupled with the tissue’s lack of blood flow contribute to ischemic wound formation and impair ischemic wound healing.

Signs and Symptoms

Ischemic wounds can be dark red, yellow, gray or black in color, and they usually do not bleed. There may or may not be swelling around the wound, depending upon if infection is present or not. The edges of the wound typically appear to be raised. If the limb is dangled down for a period of time, it will typically turn red. When elevated, this redness will turn pale and cool to the touch. Ischemic wounds are often very painful, and many individuals find the pain subsides when the leg is dangled downward. It is thought this helps the pain subside due to gravity assisting the blood flow to the area.

Who Is at Risk

Individuals with known poor circulation are at high risk for developing ischemic wounds. Other medical conditions also associated with ischemic wounds are:

• Diabetes Mellitus
• Renal (kidney) failure
• Hypertension
• Lymphedema (a condition causing fluid buildup in the legs)
• Inflammatory diseases (such as vasculitis or lupus)
• Smoking (past or present)

Treatment Options

Depending on the patient’s condition, overall health and the severity of the ischemic wound, a health care professional may recommend invasive tests or even surgery to bypass the blocked blood vessels and restore blood flow to the affected area. Debridement is not a viable treatment option for ischemic wounds as it will often lead to a worsening wound condition.  Ischemic wound treatment can vary depending upon location and patient condition, but the general goals for treatment of an ischemic wound are

• Relieve pain
• Prevention of more ischemic wounds
• Remove any irritants to the current wound
• Protect the skin surrounding the current wound and prevent spread of the ischemic area
• Monitor for signs and symptoms of infection

Additional actions to encourage healing should be taken, such as following a healthy diet, taking medications as prescribed and drinking plenty of fluid.

Prevention

Prevention and treatment of ischemic wounds begins with careful and routine inspection of the skin and feet. Proper skin and foot care is especially important for individuals with known poor circulation in the legs. Carefully examine the tops and bottoms of feet and between the toes every day. Do not wait to treat a minor skin or foot problem. Certain lifestyle choices should also be taken to help prevent ischemic wounds such as:

• Quit smoking
• Exercise per a health care professional’s recommendation
• Maintain good nutrition and adequate fluid intake
• Actively manage other medical conditions (such as high blood pressure, high cholesterol and diabetes)

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