Arterial

In assessing arterial wounds, it is important to recognize that arterial insufficiency is the lack of oxygenated blood necessary for adequate tissue functioning. This can cause pain in the calf and foot during walking or exercise. Cases of arterial insufficiency may also be associated with significant pain at the lower extremities. Care should be taken to ensure that appropriate pain management techniques are employed.

Physical findings suggesting arterial insufficiency include lack of hair growth, persistent redness or cyanosis of the toes and feet, cool or shiny skin, and the absence or reduction in foot pulses.

A very useful bedside test for arterial insufficiency is the Ankle-Brachial Index (ABI). This is obtained by checking the blood pressure at the elbow (Brachial) and at the posterior tibial artery (Ankle) location using a standard blood pressure cuff and a handheld doppler device to detect the blood flow. The division of the blood pressure at the Ankle by the Brachial blood pressure creates an index: ABI = Ankle BP/Brachial BP.

In the case of skin breakdown associated with arterial insufficiency, optimal management of medical co-morbidities facilitates the quickest healing response at wound sites. For example, improved control of congestive heart failure will promote better blood flow and oxygenation to the tissues.

In cases of arterial insufficiency, the patient's skin should be protected as if the area were an area of pressure breakdown.

Unlike pressure wounds, diabetic wounds, or burns that are described by stage, category, or degree; arterial wounds are described as either partial or full thickness. Partial thickness wounds present with damage to the epidermal and to, but not through dermal tissues, while full thickness wounds present with damage to epidermal, dermal, and subcutaneous tissues – often involving deeper structures such as fascia, muscle and/or bone.

In order to appropriately establish wound type and etiology, a thorough wound assessment should be completed as required by state and federal guidelines. 

This thorough initial wound assessment or wound reassessment (as a component of a wound status change) is described AHS’ Assessment Guideline.  It requires a detailed assessment of the whole patient and their history as well as other factors including duration of the wound, patient’s recollection of the causative factors, complaints of pain, fever, numbness or drainage