Wound Care

Ischemic Ulcer

An ischemic ulcer or arterial ulcer can result from any interruption of arterial blood supply to an area of the skin. They typically occur in the distal portion of the extremities, especially the feet. These ulcers are typically painful. Wet or dry gangrene may be associated with these types of ulcers. It is rare for an ischemic ulcer to heal if nothing can be done to improve the arterial blood supply to the area affected. The surgeons at University Surgeons Associates frequently treat patients with vascular problems.

WHAT is an ischemic ulcer?

Ischemic ulcers usually develop on the feet, frequently on the heels, tips of toes or between the toes in a patient with vascular disease.  They can occur in the nail bed if the toenail cuts into the skin or if the patient has had recent aggressive toe nail trimming or an ingrown toenail removed.  The surrounding area may be pale and cool suggesting poor blood supply.  Bleeding is rarely a problem.  They are a finding that frequently precedes the need for an amputation.

Risk factors for ischemic ulcer

  • Peripheral Arterial Disease
  • Tobacco Use
  • Diabetes Mellitus
  • Micro-vascular Disease
  • Obesity
  • Physical Inactivity
  • Family History of Vascular Disease
  • High Cholesterol
  • Hyperlipidemia
  • Hypercoagulable States
  • Hypertension
  • Atrial Fibrillation
  • Arterial Embolism
  • Mitral Stenosis
  • Endocarditis
  • Patent Foramen Ovale
  • Prosthetic Heart Valve
  • Post-Surgical Clotting
  • Radiation Necrosis
  • Trauma
  • Certain Medications
  • Cancer
  • Age

Many of these risk factors cannot be controlled but many of the most significant risk factors can be affected or improved by changes in our lifestyles.

Controllable Risk Factors

  • Stop Tobacco Use
  • Increase Physical Activity
  • Lose Weight
  • Manage Diabetes
  • Treat High Cholesterol
  • Treat Hyperlipidemia
  • Manage Hypertension
  • Anticoagulation when indicated

Targeting of only one risk factor is not as effective as improving all those that you can control.  Learn the facts.  Develop a healthy lifestyle and follow the advice of your healthcare professionals.


  • Ulcer on distal extremity
  • Punched out border
  • Poor bleeding
  • Pale and/or cool extremity
  • Dependant rubor (redness) of the extremity
  • Poor or absent pulses
  • Base is yellow, brown, gray or black
  • Painful (especially at night)
  • Drainage from ulcer
  • May  or may not have redness around the ulcer
  • May or may not have swelling
  • Redness extending up the leg
  • Pain on motion of toes
  • Fever over 101 degrees F (39 C)
  • Chills
  • Skin blisters and weeping
  • Gangrene (wet or dry)


A full medical history of the patient is evaluated.  A wound specialist will examine the wound thoroughly and begin initial therapy.  Laboratory testing and imaging studies such as noninvasive vascular studies, X-rays, CT and MRI scans may be performed to help diagnose the problems and develop a treatment plan.  A multidisciplinary approach involving the staff of the Center, the primary care physician and specialists increases the likelihood of correct diagnosis, successful wound healing and prevention of complications or recurrence.


  • Debridement of the Ulcer
  • Appropriate Dressing of the Wound
  • Treatment of Infection & Inflammation
  • Protection of the Wound
  • Sometimes Surgery to Improve Blood Supply
  • Sometimes Hyperbaric Oxygen Therapy
  • Management of Wound Pain
  • Treat Diabetes & Nutrition
  • Advanced Therapies to Stimulate Tissue Growth


Any ulcer on an extremity in a patient with vascular disease that does not heal promptly is a probable ischemic ulcer that might benefit from the specialized care available through the University Wound Care & Hyperbarics Center.  A multidisciplinary approach involving your surgeon at University Surgeons Associates, the staff of the Center, your primary care physician and vacular surgeon increases the likelihood of successful wound healing and prevention of complications or recurrence.  These difficult to heal foot ulcers frequently require weeks to months to completely heal and many of the modalities used in treatment are arduous and time consuming.  This means there must be a real commitment by the patient and their care givers to follow through with the recommendations and treatments as scheduled.  Partial or incomplete therapy almost always results in failure to heal.  The ultimate consequence of failure to heal is loss of limb or life.

If you have an established ischemic ulcer you should considered contacting your surgeon at University Surgeons Associates, your vascular surgeon, your primary care physician or the staff of the University Wound Care & Hyperbarics Center for any of the following problems:

  • Persistent fever over 101 degrees F (39 C)
  • Pain that is not relieved by your medications
  • Chills
  • Swelling
  • Bleeding
  • The wound is larger or deeper
  • The wound looks dried out or dark
  • Purulent drainage (pus) from the ulcer
  • Redness surrounding the ulcer that is worsening or getting bigger

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