Lower extremity ulcerations of any kind can be extremely painful and debilitating. It is crucial that we address the current health status, such as the presence of diabetes or vascular disease, and implement the necessary wound closure treatments. It is also important to understand that every wound has its own personality, & can require an individualized treatment plan.

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WHAT IS IT?

Diabetic foot ulcers are open sores or wounds that occur on diabetic patients. Often time patients with diabetes suffer from permanent nerve damage (neuropathy) to the nerve fibers in the feet, which can lead to a diminished ability to feel pain and pressure, detect hot and cold sensation, and maintain your balance.

This places them at additional risk for developing diabetic foot ulcers. Patients with diabetes may also have hardening of their arteries, which can affect the circulation to the feet.

SIGNS & SYMPTOMS

  • Sores that do not heal
  • Feeling of “pins and needles” in your feet
  • Lack of sensation (feeling) in your feet
  • Feet may hurt while walking or resting
  • Skin on feet may become thick, dry, or scaly
  • You may notice calluses developing easily on the soles of your feet

RISK FACTORS

  • Elevated blood sugars
  • Obesity
  • Alcoholism
  • Hyperthyroidism
  • Hypertension
  • Smoking

WE TREAT

After thorough evaluation, we will determine the current condition of the wound and develop a customized treatment plan that will include:

  • Specialized need based dressings to absorb drainage
  • Debridement
  • Evaluation, treatment, and monitoring of infection
  • Appropriate offloading shoe wear or bracing
  • Proper diet consultation

Remember, your compliance with the plan of care is the single most important factor for successful healing!

WHAT IS IT

Venous stasis ulcerations are wounds or sores that tend to occur between the ankle and knee, resulting from abnormal or damaged veins. Blood clots can form within a deep vein and cause swelling. If leg swelling is not controlled, blood will pool in the ankles and fluid will leak into the surrounding tissue, breaking down the tissue and causing an ulceration to form.

SIGNS & SYMPTOMS

  • Open sores, mostly between ankle and knee
  • Swollen ankles (most common symptom)
  • Inflammation or drainage around the affected tissue
  • Prominent varicose veins
  • Heavy or aching feeling of the legs when standing or sitting with legs down for extended time
  • periods
  • Red spots or brownish discoloration to the skin around the ankle area
  • Leathery, dry, or scaly skin over the legs

RISK FACTORS

  • History of Phlebitis or Deep vein thrombosis
  • Congestive heart failure
  • Obesity
  • Immobility
  • Persons over 60
  • Varicose Veins
  • Malnutrition
  • Smoking
  • Multiple pregnancies

WE TREAT

After thorough evaluation, which often includes noninvasive diagnostic testing, we are able to assess the ability for the wound to heal. If healing is unlikely due to underlying vascular disease, we will make the appropriate referrals to a trusted vascular surgeon for revascularization. We will continue your customized plan of care with:

  • Specialized dressings to absorb drainage
  • Debridement
  • Evaluation, treatment, and monitoring of infection
  • Proper diet consultation
  • Compression stockings and/or special pump to reduce swelling
  • Proper elevation to eliminate edema (swelling) and allow optimum circulation

Remember, your compliance with the plan of care is the single most important factor for successful healing!

WHAT IS IT?

Arterial ulcers (Ischemic ulcers) are wounds that generally occur on the toes, ankles, and heels, due to inadequate blood supply. Peripheral Arterial Disease, a condition from hardening of the arteries where plaque builds up, causes this, also known as atherosclerosis. Postponed assessment of arterial blood supply can lead to a loss in tissue and delayed wound healing.

SIGNS & SYMPTOMS

  • Painful sores that appear yellow, brown, grey, or black in color
  • Cold or cold to the touch lower limb sensation
  • Hair loss on affected extremity
  • Atrophic appearance of skin and nails
  • Gangrene
  • Non healing or slow healing wound
  • Cramps when walking
  • Constant leg pain

RISK FACTORS

  • Preexisting vascular disease
  • Tobacco use
  • Hypertension
  • Hyperlipidemia
  • People with failed vascular grafts

WE TREAT

After thorough evaluation, which often includes noninvasive diagnostic testing, we are able to assess the ability for the wound to heal. If healing is unlikely due to underlying vascular disease, we will make the appropriate referrals to a recommended vascular surgeon for revascularization. We will continue your customized plan of care with:

  • Specialized need based dressings to absorb drainage
  • Debridement
  • Evaluation, treatment, and monitoring of infection
  • Accommodating footwear
  • Proper diet consultation

WHAT IS IT?

Pressure ulcerations develop when the skin is exposed to constant pressure or friction in a particular area, mostly on skin over bony areas. This constant pressure to the area of skin disrupts the normal blood flow, causing the cells to die and the skin to deteriorate. This can be common among those who are chronically bedridden, wheelchair bound, or ambulatory with decreased sensation in the foot.

WE TREAT

After thorough evaluation, which often includes noninvasive diagnostic testing, we are able to assess the ability for the wound to heal. If healing is unlikely due to underlying vascular disease, we will make the appropriate referrals to a recommended vascular surgeon for revascularization. We will continue your customized plan of care with:

  • Special need based dressings to absorb drainage
  • Debridement
  • Evaluation, treatment, and monitoring of infection
  • Appropriate offloading shoe wear or bracing
  • Proper diet consultation

SIGNS & SYMPTOMS

  • Painful sores that appear yellow, brown, grey, or black in color
  • Cold or cold to the touch lower limb sensation
  • Hair loss on affected extremity
  • Atrophic appearance of skin and nails
  • Gangrene
  • Non healing or slow healing wound
  • Constant leg pain

RISK FACTORS

  • Preexisting vascular disease
  • Non ambulatory
  • Tobacco use
  • Elderly
  • Malnutrition

THE ROLE OF VASCULAR

When treating wounds presenting from underlying vascular disease, such as arterial ulcers or diabetic foot ulcers, it is crucial to ensure that sufficient blood flow to the lower extremity is maintained for successful wound healing results. For these cases, a reconstructive foot and ankle surgeon and a vascular surgeon will work together to implement revascularization and wound healing/foot and ankle reconstruction, to ultimately save the foot from amputation.

Peripheral Arterial Disease

PAD is a disease where there is a blockage of the arteries leading to the extremities, most commonly to the lower extremities. Those who are at greater risk of developing the disease are diabetics, smokers, those with high cholesterol, and the elderly. For many patients with the disease, there are no noticeable symptoms. However, for patients who come in reporting calve pain or present with non-healing ulcers, we refer within our network of trusted vascular surgeon for diagnosis.

Commonly Referred Vascular Services

  • Angiography
  • Revascularization

Treatment

For our patients requiring vascular treatment, we will refer within our trusted network of vascular surgeons who specialize in surgical techniques, testing, and current research.


  • BEFORE & AFTER

    Common Ulcerations

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    Disclaimer: Images are graphic in nature.

  • Diabetic Foot Ulceration

    Case 1

    Before

    After

  • Diabetic Foot Ulceration

    Case 2

    Before

    After

  • Venous Stasis Ulceration

    Case 3

    Before

    After

  • Pressure Ulceration

    Case 4

    Before

    After

  • Pressure Ulceration

    Case 5

    Before

    After

  • Arterial Ulceration

    Case 6

    Before

    After

  • Arterial Ulceration

    Case 7

    Before

    After