Author: Amy Dendale, Medical Student, University of Auckland, New Zealand. DermNet NZ Editor in Chief: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. December 2016.
An ulcer is an area of full-thickness skin breakdown. An arterial ulcer is due to inadequate blood supply to the affected area. Arterial ulcers tend to occur on the lower legs and feet, and may be acute, recurrent or chronic. Other causes of leg ulceration include venous disease, diabetes, pressure injury, skin cancer and rare causes, such as vasculitis and pyoderma gangrenosum. Ulcers may have multiple contributing factors; these ‘mixed ulcers’ constitute roughly 15% of all leg ulcers.
Arterial ulcers are also known as arterial leg ulcers and ischaemic ulcers.
Certain lifestyle factors and medical conditions have been associated with the development of arterial ulcers. These include:
Arterial ulcers are caused by arterial insufficiency; that is, inadequate delivery of oxygen and nutrient-rich blood to the tissues. Arterial insufficiency is caused by high blood pressure and narrowing of the arteries due to atherosclerosis. Atherosclerosis is due to deposits of circulating lipids at the sites of damaged vessel walls as a result of the effects of smoking and high blood pressure. These deposits partially occlude the artery, resulting in reduced blood flow to tissues.
Distinguishing features of arterial ulcers include:
Other symptoms of arterial insufficiency may also be present, such as:
The underlying cause for a leg ulcer is diagnosed by taking a thorough patient history and a careful examination. Bedside tests include:
The treatment for arterial ulcers involves addressing the relevant factors contributing to arterial insufficiency and subsequent ulcer development in an individual. This may involve:
Signs that a venous ulcer may require treatment with antibiotics include:
An arterial ulcer can be repaired by skin grafting (where a thin piece of skin is taken from another site, usually the upper thigh, and placed over the wound). A skin flap is an alternative way to cover the wound.
The surgical revascularisation of a limb aims to restore blood flow either by bypassing or angioplasty (re-opening) of narrowed vessels. This improves the healing of an ischaemic ulcer by restoring oxygen and nutrient supply to the tissue.
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