• Impairment of arterial blood flow leading to tissue ischemia and potentially necrosis • Risk factors: – Atherosclerosis – Age – Smoking – Diabetes mellitus – Hypertension – Dyslipidemia – Family history – Obesity – Sedentary lifestyle.
Arterial Ulcers • Assessment: thorough history and physical examination. • Ulcer presentation: – Location: On the feet - often on the heels, tips of toes, between the toes or anywhere the bones may protrude and rub against bed sheets, socks or shoes. – Appearance: • Base : Has a yellow, brown, grey or black color and usually does not bleed. • Borders : The borders and surrounding skin usually appear punched out. If irritation or infection are present, there may or may not be swelling and redness around the ulcer base. • There may also be redness on the entire foot when the leg is dangled; this redness often turns to a pale white/yellow color when the leg is elevated. • Arterial ulcers are typically very painful, especially at night. The patient may instinctively dangle his/her foot over the side of the bed to get pain relief.
Arterial Ulcers • Management of arterial ischemic ulcers classically includes conservative debridement, pain control, use of occlusive dressings, and improvement of circulation
Acute Arterial Occlusion • Caused by: – Trauma – Thrombus: develops in a damaged vessel by atherosclerosis – Embolism: wall of artery is healthy and obstruction is from thrombus that was dislodged from heart (A.fib, MI, heart valves…) • 90% occurs in LE • Acute obstruction causes decrease in mean and pulse pressures in the distal arteries and decreased oxygenation • Collateral circulation may develop
Acute Arterial Occlusion • Clinical manifestation: – 6P’s (discussed earlier) • Muscle necrosis may occur 2-3 hours after occlusion. • Treatment: – Surgery to correct arterial embolism (embolectomy) – Surgery to correct thrombus: arterial reconstruction to revascularize LE. – Anticoagulant therapy: heparin, warfarin – Fibrinolytic agents to dissolve thrombus or embolus – Awaiting surgery : bed rest, warm room, keep LE at room temp., prevent pressure or trauma in LE, position: level or slightly dependent LE
Amputation • Amputation is used to treat: – Injuries – Cancers – Severe limb gangrene – Lib-threatening arterial disease
Amputation • Care of a patient scheduled for LE amputation – Pre-op care • Rehabilitation team assesses patient and plans pre-op and post-op with patient BEFORE amputation • Patient assessment • Type of amputation to be performed – Open or guillotine– for infection. Stump is not closed to allow drainage then another surgery is performed for stump closure – Closed or flap– stump is closed with skin flap.
- Spring '16