Arterial Ulcer

Arterial ulcers, also known as ischaemic ulcers, are wounds that occur due to inadequate blood flow, typically in the lower extremities. They result from arterial insufficiency, where there’s a reduction in blood flow to the extremities, leading to tissue ischaemia and necrosis.

• Commonly caused by atherosclerosis, leading to decreased blood flow.
• Other causes include thromboangiitis obliterans, diabetes mellitus, and traumatic injuries to arteries.

• Reduced arterial flow leads to tissue hypoxia and necrosis.
• The lack of sufficient blood flow impairs wound healing processes.

• Located on areas of the feet and legs where there’s the least amount of subcutaneous tissue, like toes, lateral malleolus, or shin.
• Typically small, round, and well-defined with a “punched out” appearance.
• The base of the ulcer is usually pale, with minimal to no granulation tissue, and may be covered with necrotic tissue.

• Pain is a significant feature, often severe and exacerbated by leg elevation.
• Patients may report intermittent claudication or rest pain.

• Signs of peripheral arterial disease like diminished or absent pulses, pallor on elevation of the limb, and dependent rubor.
• Trophic changes such as hair loss, thin shiny skin, and atrophy of subcutaneous tissue.

• Thorough history focusing on risk factors like smoking, diabetes, and hyperlipidaemia.
• Physical examination for signs of arterial insufficiency.

• Ankle-brachial index (ABI) measurement is essential for assessing arterial flow.
• Doppler ultrasound and angiography can be used for detailed vascular assessment.

• Primary aim is to improve arterial blood flow.
• Control of risk factors like smoking cessation, glycaemic control in diabetics, and management of hyperlipidaemia.

• Local wound care includes debridement of necrotic tissue and appropriate dressing.
• Pain management is crucial due to the painful nature of these ulcers.

Revascularisation procedures, such as angioplasty or bypass grafting, may be necessary in severe cases.