Arterial ulcers are also known as ischemic ulcers or wounds, and occur typically in the ankles. These ulcers are caused by peripheral artery disease (PAD) and are also found in diabetics who struggle to manage their condition. Upon observing, these ulcers have a ‘punched-out’ and sunken appearance with grey or yellow fibrotic tissue. Patients describe these ulcers as extremely painful as they can extend down to the tendons.

How do they form?

These ulcers are mainly caused by poor blood supply to the capillaries of lower limb regions. This occurs due to weakened capillaries as the cells lining these blood vessels— endothelial cells— malfunction. Plaque build-up in arteries can disrupt blood supply and in extreme cases, cause complete blockage. This plaque is formed as a result of fatty compounds depositing (from circulating cholesterol) in the arterial vessel walls.

Blockage prevents the arteries from delivering proper blood supply to the distal regions. Reduced blood supply for prolonged periods of time then causes complete lack of oxygen to the lower limb regions and presents the opportunity for ulcers to form.

Diagnosis

The Ankle Brachial Pressure Index (ABPI) is used to measure pressure in the arm and ankle.

• Normal value is between 0.92 to 1.3
• <0.9 is indicative of arterial disease
• <0.5 indicates severe arterial disease

Treatment

In contrast to venous ulcers, compression treatment is not appropriate for arterial ulcers. The affected patient must be referred to a vascular specialist whose primary aim will be to revascularise the affected area. Treatment also involves regular, meticulous cleaning of the wound to cleanse the area and remove contaminants. Surface debris may be removed surgically or using ointments. Appropriate wet/dry dressings are then applied to the wound. A complication of arterial ulcers is cellulitis or tissue infection. In this case fever and sickness may result hence oral antibiotics are prescribed to clear this infection.

As technology progresses further modes of treatment have also been discovered, these include:

• Skin graft substitutes (bioengineered skin)
• Growth factors and cytokines- to accelerate the healing processes and reverse inflammatory processes.
• Maggot therapy- to help clean the wound