II. Signs

  1. Distribution
    1. Distal extremities
  2. Characteristics
    1. Deeper ulcers that may expose tendons and bone
    2. Punched-out lesions with well defined margins

III. Evaluation

  1. See Claudication (Peripheral Arterial Disease)
  2. Initial screening with Ankle-Brachial Index
  3. Confirmation with arterial Doppler Ultrasound or segmental limb pressures

IV. Management

  1. See Peripheral Vascular Disease Management
  2. Restoration of adequate perfusion is paramount
  3. Healable Wound Care (adequate perfusion)
    1. See TIME Principle of Chronic Wound Care
    2. Apply topical skin Emollients (e.g. Aquaphor)
    3. Wound Debridement
  4. Nonhealable Wound Care (ischemic wounds)
    1. See Peripheral Vascular Disease Management for revascularization and other interventions
    2. Avoid Wound Debridement in ischemic wounds
    3. Control infection
    4. Apply topical skin Emollients (e.g. Aquaphor)

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