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A vascular ulcer is a typically painful open wound that is usually located on the side of the foot or on the toes. These sores may be present on people with moderate to severe vascular disease or diabetes. They can be caused by a minor injury or by continuous pressure on areas with poor circulation, such as with poorly fitting shoes. Treatment of the vascular ulcer may involve simple wound dressings, medications, or even surgery, depending on the severity of the ulcerated tissue.
Most vascular ulcers are caused by poor healing from insufficient blood circulation due to vascular blockage. When examined by a medical professional, a pulse in the foot will be difficult to find and the temperature of the skin will be colder than normal. Many people report claudication, or pain in the calf that increases with physical activity, shortly before the development of the vascular ulcer. Bunions and misshapen, claw-like toes may also indicate a predilection for the formation of ulcerations.
In many cases, vascular ulcers are slow to heal due to poor blood circulation and the absence of skin tissue cells throughout the wound. Normal wounds generally have skin cells scattered across the surface of the injury. As the wound heals, these skin cells begin to grow and join together to form a new layer of healthy skin. The vascular ulcer only has skin cells located around the perimeter of the sore; new skin must grow from the outermost edges of the ulcer and join together over the center.
Vascular ulcers may be treated with a combination of therapies. Compression wraps may be recommended to protect the raw tissue and promote more efficient blood circulation. Some people with a vascular ulcer take daily blood thinners or anticoagulant medications to prevent the formation of blood clots near the ulcerated tissue. The anticoagulants may also help the ulcer heal as the blood circulation improves.
Most people with a vascular ulcer are at risk for developing an infection due to the open nature of the sore. Oral antibiotics and a topical antibiotic cream may be used to prevent and treat infection. Unlike other skin ulcers, vascular ulcers should not be debrided as part of the treatment process. Debridement, the removal of dead or damaged tissue, can cause additional damage to the surrounding skin, resulting in the spread of the ulcerated sore.
Some people with severe vascular ulcers may require surgery to restore the proper blood flow to the area. During a vein bypass surgery, the surgeon will harvest a vein from elsewhere in the body and replace the faulty vein, restoring blood flow. Another procedure used to restore blood flow is called an angioplasty; a small surgical tool is inserted into the blocked artery and slowly widened until the diameter of the artery increases, allowing for greater blood flow to the affected tissue.