Re-establishing Macro Vascular Flow and Wound Healing: Beyond the Vascular Intervention

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Author(s): 

1William J. Ennis, DO, MBA, 2Martin Borhani, MD, 3Patricio Meneses, PhD

Introduction

Since approximately 70% of wounds treated at outpatient wound centers in the United States are lower extremity venous ulcerations, we will use a leg ulcer as case study for the purposes of this article. A 65-year-old Caucasian female presents to the wound center with a 10 x 8 cm wound just above the medial malleoli. The wound has been present for 2 years and is slowly increasing in size. The skin surrounding the wound is hyperpigmented and the soft tissue is firm on palpation. The ankle circumference is 16 cm, while the mid-calf circumference is 35 cm giving the leg an “inverted champagne bottle” appearance. The wound bed is 80% yellow with a thick adherent slough noted (Figure 1). The edges of the wound are rolled over and there is no evidence of epithelial migration. The patient complains of pain that is worse at night and she develops calf pain within a 2 block ambulation distance that is relieved by standing for 5 minutes. The patient in this case suffers from a “mixed” venous/arterial ulcer, further complicating her care. A wound care work-up consists of a comprehensive history, physical exam, and a series of laboratory tests in order to arrive at a provisional diagnosis.2 As part of this work-up, the wound bed must be assessed, measured, photographed, and oftentimes, biopsied.
Much has been written about the wound micro-environment and the impact it has on healing.3 Important issues that will be discussed in this paper include the role of bacteria, inflammation, cellular proliferation, and tissue perfusion on the microenvironment.

References: 

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