WOUND HEALING
Getting to the Heart of the matter
A majority of lower extremity wounds occur due to underlying vascular disease. At CPPG we use a holistic interdisciplinary approach to healing lower extremity wounds as efficiently as possible.
Thorough testing and clinical evaluation including vascular ultrasound, nutritional assessment, radiographic studies, and detailed medical assessment are performed. This is followed by intensive local wound care with multiple advanced techniques and modalities.
Several chronic wounds have mixed etiologies complicating healing. Most commonly, diabetes, Peripheral Arterial Disease (PAD), and venous insufficiency. Patients with PAD and lower extremity wounds are at higher risk for cardiovascular death,
( >20% within a year) therefore, thorough cardiac evaluation and aggressive medical management usually follow.
Gerald Gronborg, DPM, FACFAS
Dr. Jacob Carmichael, DPM, FACFAS
Wound Healing Education
Common Types of Wounds
Venous Insufficiency Ulcerations
Blood can reach the extremity but is unable to effectively return to the heart. Veins contain valves that direct the one-way blood flow- the insufficient valves prevent the backflow of blood. If the cause of the wound is venous insufficiency a LASER ablation procedure of the superficial vein is the treatment. Sometimes, placing a stent in the iliac veins is needed if venous compression syndrome is found to be the cause.
Arterial Insufficiency Ulcerations
Insufficient arterial flow to an extremity. “Hardening of the arteries” or any other condition that limits blood flow to the extremities (PAD). If vascular testing reveals significant arterial disease (Blockage) a procedure to open the occluded artery will likely follow.
Diabetic/Neuropathic Ulcerations
Etiologies can be multifactorial. Diabetes with prolonged periods of hyperglycemia (high blood sugar) can contribute to excessive callous build-up, diminished or absent sensation to pain, temperature, and position, reduced or absent sweating can contribute to these type of ulcerations of the foot. A combination of these over time can contribute to severe breakdown of joints in the foot and ankle known as Charcot joints. These can occur gradually or suddenly and can be complicated by poor blood flow, non- adherence with diabetes and nutrition management. Other types of Wounds that can lead to chronic non-healing are those Trauma and Surgical Complications; such as incision dehiscence or breaking down of the tissue due to local infection, poor blood flow or improper post-operative adherence to care.
Treatments
Advanced Dressings
Skin Substitutes
Common Problems
Bunions
Heel Spurs
Ingrown Toenails
Warts
Hammertoes
Plantar Fasciitis
Foot/Ankle Sprains
Tendonitis
Fractures
Warts
Skin conditions of LE, HT and Bunion together
Treatments
Foot Orthotics
Laser Treatments
Surgical Reconstruction
Medical
Therapy
When to Seek Evaluation
Enlarged swollen joints
Frequent foot or calf cramping
Constant cold feet
Clubbing toenails
Red swollen digits or foot/ankle
Loss of hair on feet or lower legs,
dry, flakey skin on feet
painful walking,
injury greater than 72 hours
