Can peripheral vascular disease (PVD) ulcers be left open to air?

Management of Peripheral Vascular Disease (PVD) Ulcers

PVD ulcers should not be left open to air as they require proper wound care including appropriate dressings and compression therapy to promote healing and prevent complications.

Understanding PVD Ulcers

PVD ulcers result from inadequate blood flow to the tissues, leading to tissue damage and poor healing. These ulcers:

• Are often painful
• Have a gangrenous appearance
• Are resistant to standard topical treatments
• Require specialized management approaches

Evidence-Based Management Approach

1. Initial Assessment and Revascularization

The first priority for PVD ulcers is to assess and restore blood flow:

• Evaluate the entire lower extremity arterial circulation with detailed visualization of below-the-knee and pedal arteries 1
• Consider revascularization when appropriate to restore direct flow to at least one foot artery, preferably the one supplying the ulcer area 1
• Aim for minimum skin perfusion pressure ≥40 mmHg, toe pressure ≥30 mmHg, or TcPO2 ≥25 mmHg 1

2. Wound Care Principles

After addressing blood flow issues, proper wound care is essential:

• Do not leave wounds open to air - this can lead to drying, increased risk of infection, and delayed healing
• Use appropriate wound dressings to maintain a moist wound environment
• Negative-pressure wound therapy dressings are helpful after revascularization and minor amputation when primary or delayed secondary closure is not feasible 1
• Regular debridement of necrotic tissue is often necessary 1

3. Compression Therapy

• Compression therapy is the mainstay of treatment for venous components of ulcers 1
• Must be used cautiously in patients with mixed arterial/venous disease
• Should only be applied after adequate revascularization in patients with significant arterial disease

4. Adjunctive Therapies

Consider these additional approaches for challenging cases:

• Intermittent pneumatic compression devices may augment wound healing and ameliorate severe ischemic rest pain in patients with critical limb ischemia (CLI) 1
• The effectiveness of hyperbaric oxygen therapy remains uncertain for PVD ulcers 1
• Prostanoids are not indicated in patients with CLI 1

5. Multidisciplinary Care

PVD ulcers require comprehensive management:

• After revascularization, patients should be treated by a multidisciplinary team 1
• Address infection with appropriate antibiotics when present
• Implement biomechanical offloading to reduce pressure on ulcerated areas
• Control blood glucose in diabetic patients
• Treat co-morbidities that may impair healing 1

Special Considerations

Infection Management

• Patients with signs of PAD and foot infection are at particularly high risk for major limb amputation and require urgent treatment 1
• Infections in diabetic patients with PVD tend to be polymicrobial and require systemic antibiotic therapy 1

Cardiovascular Risk Management

All patients with ischemic foot ulcers should receive:

• Support for smoking cessation
• Treatment of hypertension
• Control of glycemia
• Statin therapy
• Low-dose aspirin or clopidogrel 1

Pitfalls to Avoid

1. Leaving wounds open to air - this outdated practice can lead to wound desiccation and delayed healing
2. Applying compression without adequate arterial assessment - can worsen ischemia in patients with significant arterial disease
3. Delaying revascularization - timely restoration of blood flow is critical for healing
4. Overlooking infection - can rapidly progress in ischemic tissue
5. Focusing only on local wound care - systemic factors significantly impact healing potential

By following these evidence-based guidelines, PVD ulcers can be effectively managed to promote healing, prevent complications, and improve patient outcomes.