Lecture 4: Arterial Leg Wounds

what are 4 risk factors for PAD?

1. age 65+
2. age 50-64 w risk factors for atherosclerosis (DM, smoking hx, dyslipidemia, HTN), CKD, family hx PAD
3. age <50 w DM + 1 more atherosclerosis risk factor
4. persons w known atherosclerotic dz in another vascular bed

what are 7 foot wound risk factors in people with PAD?

1. previous foot wound or amputation
2. charcot foot
3. DM w poor glycemic control
4. CKD
5. peripheral neuropathy
6. corns or callouses
7. ongoing smoking

what is the typical leg appearance of people with arterial wounds? (Pt 1 - 5)

1. thin, shiny, dry skin
2. hair loss on ankle and foot
3. dystrophic (thick) or yellow toenails
4. elevation pallor
5. dependent rubor

what is the typical leg appearance of people with arterial wounds? (Pt 2 - 4)

6. dec temp
7. absent or diminished pulses
8. cyanosis
9. ischemic pain

PAD foot exam: vascular testing ; what ABI indicates that a arterial US should be done?

if ABI < 0.6 or toe brachial index if ABI > 1.4
- speak w primary care
- ask for vascular surgery consult

what do you do for the buerger's test?

elevate limb 45 degrees for 1-2 mins, observe , place in dependent position

what are some preventions for arterial wounds? (5)

1. foot self-care education
2. foot inspection every health care visit
3. therapeutic foot wear for high risk pts
4. comprehensive foot eval yearly
5. referral to a foot specialist when available

whats included in wound care for arterial wounds? (4)

1. protect and offload area
2. sharp debridement of nonviable tissue as indicated. Leave any stable, dry eschar in place
3. appropriate dressings, for stable, dry eschar, apply povidone iodine and gauze
4. monitor for infection and control edema as able

what should we manage as a medical team for pts w arterial ulcers?

1. vascular surgery referral
2. management of infection and/or inflammation
3. pain control
4. smoking cessation
5. glycemic control

what is considered to be urgent referrals?

1. gangrene in outpatient or non-acute setting
- obtain urgent referral to vascular surgeon, be in comm w primary physician and document this. consider ER if gangrene moist or worsening

2. gangrene in acute setting
- notify physician, ask to order arterial US and vascular surgery consult

what do we do for venous and arterial (neuropathic, trauma, and pressure) wounds? treatment

1. treat the cause if possible
- ask for referral to vascular surgeon
- no compression bandaging if ABI <=0.5
2. local wound care

differentiate wound type chart

review slide 56

whats included in a leg exam? (neuro)

1. light touch
2. sharp/dull
3. 5.07 monofilament optional

whats included in a leg exam? (vascular)

1. pulse palpation and handheld doppler
2. ABI
3. check skin condition (appearance, texture, temp)
4. edema (girth, pitting)

what is the typical anatomic location of arterial wounds?

>> At Foot and Malleoli <<
- btwn toes
- tips of toes
- pressure points (heel or lat foot)
- sites of trauma or footwear rubbing

What is the typical presentation of an arterial wound?
- Location:
- Wound Base:
- Wound Edge:

L: distal to ankle, usually at foot and malleoli, sites of pressure from footwear, trauma, pressure
WB: pale or necrotic
E: well-defined, 'punched out'

What is the typical presentation of an arterial wound?
- Periwound:
- Pain:

PW: thin, shiny, may be blanched or purpuric; hair loss and nail changes common
P: often severe, commonly worse w limb elevation

what are the 4 subsets of LE PAD?

1. asyptomatic PAD
2. symptomatic PAD
3. critical limb-threatening ischemia
4. acute limb ischemia

whats included in a PAD foot exam?

REVIEW SLIDES 39-42 its alot