ulcerations due to peripheral vascular disease

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Ulcerations Due to Peripheral Vascular Disease. Mark Finkelstein DPM Board-Certified, American Board of Podiatric Surgery Board-Certified, American Board of Podiatric Medicine. Comprehensive Assessment. - PowerPoint PPT Presentation

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Arterial Ulcerations due to Peripheral Vascular Disease

Ulcerations Due to Peripheral Vascular DiseaseMark Finkelstein DPM

Board-Certified, American Board of Podiatric Surgery

Board-Certified, American Board of Podiatric Medicine Comprehensive AssessmentComplete History and Physical- claudication?, Rest pain, night pain? History of smoking?

Lower extremity examination-always check between the toes

Wound assessment-infection,size,depth,exudate,base

Vascular assessment-Pulses, Non Invasive testing, Angiogram

Arterial Ulcer CharacteristicsLocated on bony prominences of the legs and feetPunched-out appearance with well-defined bordersShiny atrophic skin, no hair growthLittle/no edema or wound exudateYellow slough or black eschar in the wound bed with little granulation tissueFeet are cool to touch and pedal pulses are often not palpableArterial Ulcer Characteristics

Assessment of Pedal Pulses

Vascular Assessment-Clinical

Elevation Pallor Dependent RuborTreatment of Arterial DiseaseRefer for vascular evaluationCardiovascular disease should be identified and managedRecommend tobacco cessationIncrease regular exercise to improve symptoms of claudication7Treating The Arterial WoundDo not debride dry, stable eschar until perfusion status is determinedFor ulcers with insufficient flow, maintain dry, stable eschar

Treating the Arterial WoundFor ulcers with sufficient arterial flow, implement moist wound healing, enzymatic debridement and proper offloadingTreat infection promptly -consider Infectious Disease Consult

Vascular assessmentNoninvasive vascular testing

Vascular Assessment Evaluate vascular status with angiogram

Vascular treatmentEndovascular- Techniques

Vascular treatmentSurgical Bypass-

Evaluate risk factors for atherosclerosisSmoking, diabetes, hypertension, hypercholesterolemia, advanced age, obesity, family historyReview of labs to identify risk markers elevated total cholesterol, triglycerides and reduced high density cholesterolMultidisciplinary approachMedical therapy- beta blockers, statins, ACE inhibitors and antiplatelet therapy2. Teach chronic disease management4. Tobacco cessation programs

3. Optimize nutrition5. Evaluate functional, cognitive and emotional state of the patient

Multidisciplinary approachIncrease regular exercise and physical activity to improve symptoms of claudication

Proper pain control of ulcerations

Arterial ulcers -SummaryRequires a multidisciplinary approach for proper management Wound Care Specialist-Podiatrist, Wound NurseVascular /Interventional RadiologistVascular surgeonPrimary Care PhysicianDietitianMental Health ProviderOrthotistPhysical TherapistPain Management Specialist

Arterial ulcerationsQUESTIONSTHANK YOU