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Ischemic ulcers - self-care

Ischemic ulcers (wounds) can occur when there is poor blood flow in your legs. Poor blood flow causes cells to die and damages tissue. Most ischemic ulcers occur on the feet and legs. These types of wounds can be slow to heal.

Alternative names

Arterial ulcers - self-care; Arterial insufficiency ulcer self-care; Ischemic wounds - self-care

Causes

Clogged arteries (atherosclerosis) are the most common cause of ischemic ulcers.

  • Clogged arteries prevent a healthy supply of blood from flowing to the legs. This means that the tissues in your legs don't get enough nutrients and oxygen.
  • The lack of nutrients causes cells to die, damaging the tissue.
  • Damaged tissue that does not get enough blood flow also tends to heal more slowly.

Conditions where the skin becomes inflamed and fluid builds up in the legs can also cause ischemic ulcers.

Often people with poor blood flow also have nerve damage or foot ulcers from diabetes. Nerve damage makes it harder to feel an area in the shoe that rubs and causes a sore. Once a sore forms, lack of blood flow makes it harder for the sore to heal.

Symptoms

Symptoms of ischemic ulcers include:

  • Dark red, yellow, gray, or black sores.
  • Raised edges around the wound (looks punched out).
  • No bleeding.
  • Deep wound through which tendons may show through.
  • Skin on the leg appears shiny, tight, dry, and hairless.
  • Dangling the leg down off the side of a bed or chair causes the leg to turn red.
  • When you raise the leg it turns pale and cool to touch.
  • Leg pain, often at night. Pain may go away when the leg is dangled down.
  • Ulcer may or may not be painful.
  • Wounds may appear on legs, ankles, toes, and between toes.

Who is at risk?

Anyone with poor circulation is at risk for ischemic wounds. Other conditions that can cause ischemic wounds include:

  • Diabetes
  • Diseases that cause inflammation, such as lupus
  • High blood pressure
  • Kidney failure
  • Lymphedema, which causes fluid to build up in the legs
  • Smoking

Wound care

To treat an ischemic ulcer, your doctor will try to restore blood flow to your legs. You may need to take medicine. In some cases, you may need surgery.

Your provider will show you how to care for your wound. There are different kinds of dressings you can use including gauze, gel, foam, film, or others. Ask which one is best for your wound.

  • Always keep the wound clean and bandaged to prevent infection.
  • Your doctor or nurse will tell you how often you need to change the dressing.
  • Before applying a dressing, cleanse the wound thoroughly. Ask your doctor which cleanser to use.
  • You may be able to change your own dressing, or family members may be able to help.
  • A visiting nurse may also help you.

Keep your dressing and the skin around it dry. Try not to get healthy tissue around your wound too wet from your dressings. This can soften the healthy tissue and cause more foot problems.

Prevention

If you are at risk for ischemic ulcers, taking these steps may help prevent problems.

  • Check your feet and legs every day. Check the tops and bottoms, ankles, heels, and between your toes. Look for changes in color and red or sore areas.
  • Wear shoes that fit properly and don't rub or put pressure on your feet. Wear socks that fit. Socks that are too big can fold up in your shoes and cause a sore.
  • Don't cross your legs when sitting. This can cut off blood flow to your legs. Try not to sit or stand too long in one position.
  • Protect your feet from the cold.
  • Do not walk barefoot. Protect your feet from injury.
  • Don't wear compression stockings or wraps unless told to by your doctor. These may restrict blood flow.

Certain lifestyle changes can help prevent ischemic ulcers. If you have a wound, taking these steps can improve blood flow and aid healing.

  • Quit smoking. Smoking can lead to clogged arteries.
  • If you have diabetes, keep your blood sugar levels under control. This will help you heal faster.
  • Exercise as much as you can. Staying active can help with blood flow.
  • Eat a healthy diet and get plenty of sleep at night. Staying healthy will help wounds heal.
  • Lose weight if you are overweight.
  • Manage your blood pressure and cholesterol levels.

When to call your doctor

Call your doctor if you have any signs and symptoms of infection, such as:

  • Redness, increased warmth, or swelling around the wound
  • Extra drainage
  • Pus
  • Odor
  • Fever or chills
  • Increased pain

References

Bonham PA, Flemister BG. Guideline for management of wounds in patients with lower-extremity arterial disease. Mount Laurel, NJ: Wound, Ostomy, and Continence Nurses Society; 2008.

Hafner A, Sprecher E. Ulcers. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia, PA: Mosby Elsevier; 2012: chap 105.

Hopf HW, Ueno C, Aslam R, Burnand K, Fife C, Grant L. et al. Guidelines for treatment of arterial insufficiency ulcers. Wound Rep Reg. 2006; 14(6): 693-710.

Update Date: 6/1/2014

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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