Arterial ulcer with exposed tendon

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Hi! Dialysis Pt with history of PAD,left BKA, bedbound and right leg contracture. Right lateral foot has arterial ulcer with exposed tendon. Pt non adherent to offloading. Referred to vascular, pt is not a good candidate for intervention. Im using medihoney to keep it moist and at the same time it is what readily available for the Pt. Is there anything else I can use for the dressing or do at this point?

Thank you,
Erika

May 6, 2024 by Erika Vargas, APRN

1 replies

Elaine Horibe Song
MD, PhD, MBA

Hi Erika

From your description, it seems like this arterial ulcer is currently in the maintenance/non-healable track. This topic "Arterial Ulcer - Treatment" and its algorithm provides details on management of maintenance/non-healable arterial ulcers. In summary:

For all patients with AU, it'd be important to consider (if applicable): medical therapy with antithrombotic therapy, statin, management of hypertension, diabetes. Mitigate/ eliminate any factors impeding healing, correct nutritional deficiencies; eliminate pressure/friction/shear forces, control edema, offloading, control bioburden and infection. If the patient smokes, or lives in a household where someone smokes (secondhand smoke), smoking cessation counseling is recommended.
For non-healable or maintenance arterial ulcers (AUs), palliative wound care goals include prevention of ulcer progression and complications (e.g. infection), pain relief, bioburden control. Patient's concerns and comfort should be prioritized when creating a treatment/care plan.
As for local wound care, it's important to keep the AU dry (i.e. avoid all sources of moisture, such as foot soaks, creams and ointments, to reduce risk of infection), protect from physical harm/injury, and avoid debridement.

For infection/bioburden control (note: Medihoney is also a viable option):

If minimal or light exudate, consider antiseptic solution (e.g. povidone iodine, chlorhexidine)
If moderate or heavy exudate, consider non-adherent antimicrobial dressings (with cadexomer iodine, silver, etc)
If signs of clinical infection, collect culture, prescribe empiric antibiotics, then adjust according to culture results
If life-threatening infection (e.g. gas gangrene or necrotizing fasciitis), the patient may need limb amputation.

For moisture balance:

Apply appropriate non-adherent dressing OR
If minimal or light exudate: paint daily wound with antiseptics (e.g. povidone iodine)
If dry or wet gangrene: do not use moisture-retentive dressing, as it may cause limb threatening infection
Avoid conventional dressing products that require daily dressing changes

Hope this helps!

May 7, 2024

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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