Guidelines for the prevention of lower extremity arterial ulcers

Abstract

The Wound Healing Society (WHS) is a professional society of physicians, nurses, physical therapists, podiatrists, and other wound care specialists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound healing. To that end, the following comprehensive, evidence-and consensus-based guidelines were developed to address the Prevention of Lower Extremity Arterial Insufficiency Ulcers. The guidelines are presented in generic terms; the details of specific tests, therapies, and procedures are at the discretion of an interdisciplinary team of health care professionals who establish, implement, and evaluate policies and procedures directed at prevention of arterial ulcers. METHODSAs with the arterial ulcers treatment guidelines published in 2006, 1 PubMed, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews were searched and reviewed for evidence on arterial insufficiency ulcer prevention. In addition, a search of health care databases for current evidence-based guidelines addressing the prevention of arterial insufficiency ulcers was conducted using electronic and online resources. The panel classified studies based on whether the intervention being evaluated addressed arterial ulcer risk screening and assessment, arterial ulcer prevention plans of care (including interdisciplinary approaches), or patient and caregiver education.Evidence references for each standard are listed and coded. The code abbreviations for the evidence citations were as follows:

Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults

“…Aspirin, for example, delays progression of PAD and reduces need for revascularization. 57 The characteristic symptom of PAD is distal leg pain with ambulation (intermittent claudication [IC]). Rest pain, particularly at night, can develop as ischemia worsens.…”

Arterial Disease Ulcers, Part 2

“…11,13 Short-term results of intra-arterial and intramuscular injections of bone marrow mononuclear cells are also promising in rest pain reduction, ulcer healing, and postponing or avoiding amputation. 9,12 Patient smoking cessation strategies are also helpful and should include educational, pharmacological, and behavioral techniques. 12 Exercise is recommended (30 minutes per day, 3 times a week) to increase arterial blood flow.…”

“…9,10 Prevention is better than cure. Unfortunately, methods for reversing hypoxia in chronic wounds are often complex and expensive.…”

Vascular Assessment in Patients With a Lower Limb Wound: A Correlational Study of Photoplethysmography and Laser Doppler Flowmetry Toe Pressure Techniques

“…2 Arterial disease occurring in the lower extremity often results in tissue ischemia and ulceration and is a significant barrier to the wound healing process. 1,3 Patients who fail to heal may progress to gangrene and/or chronic limb-threatening ischemia (CLTI) and finally toward an amputation process. [4][5][6] Due to its numerous impacts on patients and its socioeconomic burden, PAD demands a responsive approach to ensure the early detection, with noninvasive tests, and treatment.…”