There are two culprits for why non-healing ulcers may form on your extremities; they are typically caused by a traumatic wound or prolonged and sustained pressure. The wound is then unable to heal properly because of underlying venous or arterial issues. Most wounds are venous stasis ulcers, or caused by underlying venous insufficiency. Arterial ulcers, or ischemic ulcers, are caused by limited blood supply to the extremities due to atherosclerotic buildup in the arteries.
Venous ulcers form from untreated venous insufficiency. These types of wounds tend to be irregular in appearance. Venous ulcers may begin small in size. If left untreated, they could grow to be massive and deep, sometimes penetrating all the way to the bone. While venous ulcers can form from a trauma to the skin, they also form from excessive swelling to the extremity. For this reason, the wound will often ooze a pus or clear liquid. They are typically very painful and tend to be located on an area of the skin where the bone is close to the surface, like the ankle or side of the foot.
Treatments for venous ulcers include:
Venous Closure Procedures
At Milford Vascular, we most commonly treat our patients with an UNNA Boot. This boot is a medicated, compression garment. The boot is applied and left on for a week.
Milford Vascular is now offering a state of the art, stem cell therapy for patients with deep, chronic, non-healing wounds. Dr. Paul Davis, our interventional radiologist, specializes in the application of this treatment. This innovative treatment has expedited the healing process for many of our wound patients.
Arterial ulcers differ from venous ulcers in that the borders of an arterial ulcers are well-defined. There is an abrupt transition from healthy skin to wound. The skin surrounding the ulcer may also be reddish and shiny in appearance. The skin will also feel cold to the touch. Arterial ulcers may end up leading to gangrene, or tissue death. The skin will appear very dry and the area will be purple or black.
To heal an arterial ulcer, blood flow must be restored to the ischemic area. Typically, the only way to restore this blood flow, once the symptoms have progressed to the point of ulceration, is through surgery. There are many types of surgery available. Typically, your surgeon will begin by performing an angiogram. This invasive, diagnostic test will help them determine the site of the blockage. They will then decide whether to perform an atherectomy, angioplasty, or to place a stent. Atherectomy is when the surgeon uses a catheter with a blade on the tip to extract the plaque build up from inside the artery. An angioplasty is a procedure where the surgeon uses a catheter with a balloon tip to expand the walls of the artery to restore blood flow. Sometimes, neither of these procedures reopen the vessel sufficiently. In this case, the surgeon would then place a stent, a small wire mesh tube, to permanently hold the arterial wall open.
At Milford Vascular Institute, we perform these procedures in our office at our Outpatient Based Laboratory (OBL) every week. Our OBL offers the state of the art technology and procedures of a leading hospital, with the comfort and convenience of a quick trip to the doctor.
If the disease continues to progress, your surgeon may then decide to perform a bypass surgery. During these procedures, surgeons create an alternate route for blood flow to avoid the area of blockage and restore direct flow to the peripheral extremity.These are major surgeries that require general anesthesia and at least one overnight stay in the hospital.
If the above surgeries fail, the patient may begin to develop gangrene. When tissue dies, it must be removed to prevent the surrounding areas from dying as well or from becoming infected. This means, the patient may require amputation of the affected areas.
If you have further questions regarding a wound you or a loved one may be developing, contact the vascular specialists at Milford Vascular today at (203)882-VEIN (8346).