Arterial Ulcer Care

An arterial ulcer develops when peripheral arterial disease (PAD) limits oxygenated blood flow to the skin and deeper tissues. The wound is not primarily a skin problem; it is visible evidence that the limb’s blood supply cannot meet tissue demand. Arterial ulcers usually occur at distal sites where perfusion is already least robust: the toes, forefoot, heel, or lateral malleolus. They often have sharply defined, “punched-out” edges and a pale, gray, or necrotic wound base. Drainage is usually scant because inadequate arterial flow also limits exudate production. Ischemia causes pain, especially at night or with elevation. Raising the limb further reduces arterial pressure at the foot, so a patient may sit with the leg dependent to obtain relief. This position can produce dependent rubor: a dusky red color that appears when the foot hangs down and fades to pallor when it is elevated. The surrounding limb commonly looks and feels poorly perfused: cool skin, diminished or absent pedal pulses, shiny hairless skin, delayed healing, and thickened nails. Pain may be less obvious in a patient with diabetic neuropathy, so an...