Arterial Ulcer Care

An arterial ulcer develops when arterial blood flow cannot deliver enough oxygen and nutrients to meet tissue demand. The skin breaks down most readily at distal sites with little soft-tissue protection: the toes, forefoot, heel, lateral malleolus, or areas exposed to footwear pressure. The ulcer is often small, round or “punched out,” and deep relative to its diameter. Its base may be pale, dry, or necrotic, with little drainage unless infection is present. Surrounding skin may be cool, shiny, thin, hairless, and pale or dusky. Pulses may be weak or absent. Pain is a major clue. Ischemic pain often worsens when the leg is elevated because gravity no longer assists the limited arterial flow. A patient may describe waking with severe foot pain and sitting at the bedside with the leg dependent for temporary relief. Persistent rest pain, tissue loss, or gangrene in a person with peripheral arterial disease suggests chronic limb-threatening ischemia and requires urgent vascular assessment. A small wound can represent a large perfusion problem. The experienced nurse notices the cool, painful foot and changing colour before focusing...