Arterial Ulcers

Arterial ulcers, also referred to as ischemic ulcers, are caused by poor perfusion (delivery of nutrient-rich blood) to the lower extremities. Arteries are responsible for carrying nutrient- and oxygen-rich blood to the various tissues in the body. Arteries can slowly become narrowed and blocked as a consequence of age, smoking, high blood cholesterol or diabetes. Less blood reaching the muscles in the legs makes them hurt, like angina makes the heart muscle hurt. Other than pain, the most common symptoms of PAD are cramping or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again. Such arterial pain is described as claudication or rest pain. Over time, the reduced blood flow leads to tissue ischemia (causing the “blue toe syndrome” for example), tissue death or necrosis (gangrene), and/or ulceration.

 

In addition, the lack of blood supply can result in minor scrapes or cuts failing to heal and eventually developing into ulcers.

 

The arterial ulcer has a punched-out look, with well-defined, even wound margins. Arterial ulcers are often found between or on the tips of the toes, on the outer ankle, or where there is pressure from walking or footwear. The wounds are usually deep, often extending down to the underlying tendons, and frequently have no signs of new tissue growth. The base of the wound typically does not bleed, and is yellow, brown, grey or black in color.

 

Often the limb feels cool or cold to the touch, and has weak to absent pulse. The skin may appear shiny, thin, dry and tight with loss of hair. These ulcers are generally very painful, especially while exercising or during the night

 

Treatment of Arterial Ulcers

 

People with PAD are three times more likely to die of heart attacks or strokes than those without PAD. The goals in treating patients with ischemic ulcers are: reducing cardiovascular risk factors, relieving ischemic pain, healing ulcers, preventing major amputation, preservation of mobility, improving quality of life and increasing survival.

 

If your disease has advanced, your physician may recommend surgical or minimally invasive treatments. The choice of the treatment depends upon the pattern and extent of the blockages as well as other factors, such as your general health and the presence of other medical conditions.

 

The surgical options are:

 

• Angioplasty and stent placement of the peripheral arteries (to open up the blood vessels of the affected leg)
• Peripheral artery bypass surgery of the leg (to direct blood flow around the blocked area of the artery)

Medical therapy includes administration of analgesics, local wound care and pressure relief, treatment of infection, and aggressive therapy to modify atherosclerotic risk factors such as quitting smoking, keeping blood pressure, blood sugar, blood cholesterol and triglyceride levels under control, and losing weight if overweight.

 

Arterial leg ulcers are difficult to heal due to many complex issues, including:

 

• Poor blood circulation (ischemia)
• Disrupted epidermal barrier and susceptibility to infection
• Necrotic tissue hard to be removed without harming viable tissue
• Eschar and fibrous tissue formation
• Infection with antibiotic-resistant biofilms
• Prolonged inflammation
• Sometimes swelling (edema)
• Pain (especially at night)
• Patient’s resistance to life style modification (e.g., quit smoking, adopt a healthy diet and exercise regimen, and maintain a healthy weight)

Facing these challenges and to improve the speed and quality of healing, one may consider using a multi-functional botanical therapy with these features:

 

• Including botanicals with broad-spectrum anti-microbial properties to protect wound bed from infection and to inhibit formation and growth of bacterial biofilms without harming nascent, delicate regenerating tissue;
• Employing naturally anti-inflammatory and analgesic botanicals to suppress prolonged inflammation and pain;
• Combination with botanicals that promote microcirculation of the low extremities to facilitate autolytic debridement of necrotic tissue and to promote tissue regeneration;
• Ability to absorb wound fluid (exudate) and reduce malodor, and yet maintain a physiologically moist wound healing environment without causing maceration
• Allowing painless and less frequent dressing change;
• Healing wounds fast and effectively with maximum restoration of skin function and minimal scarring to reduce the chance of recurrence.