II. Signs
- Distribution
- Distal extremities
- Characteristics
- Deeper ulcers that may expose tendons and bone
- Punched-out lesions with well defined margins
III. Evaluation
- See Claudication (Peripheral Arterial Disease)
- Initial screening with Ankle-Brachial Index
- Confirmation with arterial Doppler Ultrasound or segmental limb pressures
IV. Management
- See Peripheral Vascular Disease Management
- Restoration of adequate perfusion is paramount
- Healable Wound Care (adequate perfusion)
- See TIME Principle of Chronic Wound Care
- Apply topical skin Emollients (e.g. Aquaphor)
- Wound Debridement
- Nonhealable Wound Care (ischemic wounds)
- See Peripheral Vascular Disease Management for revascularization and other interventions
- Avoid Wound Debridement in ischemic wounds
- Control infection
- Apply topical skin Emollients (e.g. Aquaphor)