What arterial ulcers and mixed wounds are
An arterial ulcer is a wound that forms, or fails to close, because narrowed or blocked arteries cannot deliver enough blood to the skin. A mixed wound has both artery and vein disease behind it. Gateway arranges arterial ulcer and mixed wound care in St. Louis and the Metro East with partner clinicians.
Arterial ulcers usually stem from peripheral artery disease. They tend to appear on the toes, the top or side of the foot, the heel, the outer ankle or the shin, and often look round with sharp edges, a pale or dark base and little drainage. They are frequently painful, and the skin nearby may be cool, thin, shiny and hairless.
A mixed wound may look like a swollen, draining venous ulcer, but the reduced arterial flow changes which treatments are safe. Our guide to venous and arterial ulcers compares the two.
Gateway arranges care for this kind of wound across the region. See wound care in St. Louis for how visits at home and in facilities are set up.
Why arterial and mixed wounds can be slow to heal
New tissue needs oxygen and nutrients, and both arrive by blood. When flow is low, the body struggles to rebuild skin or fight infection. Care therefore focuses on the blood supply as much as on the wound. Other factors add to the problem:
- Tobacco and nicotine, which tighten blood vessels
- Diabetes, kidney disease, high blood pressure and high cholesterol, which damage arteries over time
- Small injuries from tight shoes, a bumped shin or nail trimming
- Swelling in a mixed wound, where the usual compression may need to be lighter or avoided
- Infection, which can advance quickly in tissue with a poor blood supply
What the treating clinician considers
The first question is how much blood is reaching the area. The treating clinician typically reviews:
- Pulses in the foot, skin temperature and color
- Circulation test results, or whether tests are needed
- When pain occurs, especially at night or with the legs raised
- Whether the wound is dry and stable or wet, draining and possibly infected
- Whether a vascular specialist should evaluate options for improving blood flow
Steps that are routine for other wounds, such as removing tissue or applying firm compression, may be held or modified until blood flow is known. The guide to circulation tests before compression explains the common tests.
Care at home and in facilities
Artery disease often brings foot pain and a short walking distance, which makes regular clinic trips difficult. A home visit lets the clinician check the wound, look at footwear and see whether heels and toes are protected in bed and in a chair.
In facilities, partner clinicians see residents on site and share orders with nursing staff. When the clinician orders vascular testing or a specialist visit, Gateway helps with vascular referral coordination, including records and transportation arrangements.
How primary care factors in
The process that narrows leg arteries can also affect the heart and brain, so blood pressure, cholesterol, diabetes and tobacco use all matter. A primary care clinician manages those conditions and the related medications.
Gateway can arrange primary care at home with attention to circulation and vascular health. If you smoke, smoking and wound healing explains why clinicians bring it up.
Changes to report and when to call 911
Report these to the treating clinician promptly:
- Pain that is increasing, or new pain at rest or at night
- Skin around the wound or on a toe turning darker, blue or black
- A wound that is getting larger, or new sores on the toes or heels
- A dry, dark area that becomes soft, wet, draining or foul-smelling
- Redness, warmth, swelling or fever
- One foot that is clearly colder than the other
Call 911 if a leg or foot suddenly becomes cold, pale or blue, numb, very painful or hard to move. These can be signs that blood flow has been cut off. Also call 911 for chest pain, trouble breathing, or stroke signs such as a drooping face, arm weakness or slurred speech.
How Gateway helps arrange arterial and mixed wound care
These wounds usually involve several offices: wound care, vascular, primary care and sometimes podiatry. Gateway keeps records and test results moving among them.
Patients and families can call 314-325-0126 or request care online with a name and phone number only. We ask about your location and care setting, explain what records are needed and confirm whether visits are available there. Benefits depend on the treating provider, your plan and the care needed. Vascular, surgical and primary care offices can refer a patient for wound follow-up between their own appointments.
Common questions
Why does my foot hurt more at night or when I raise my legs?
When your foot hangs down, gravity helps blood reach it. Lying flat or raising the legs removes that help, and tissue already short on blood can ache or burn. Tell the clinician if this happens, because pain at rest is an important sign of reduced blood flow.
Is compression ever used on a mixed wound?
Sometimes. If testing shows that enough blood is reaching the foot, a clinician may order a lighter or modified form of compression to control swelling. If arterial flow is too low, compression may be avoided. This is decided case by case after a circulation assessment.
Will I need to see a vascular specialist?
A vascular evaluation is common when an arterial wound is suspected, since improving blood flow can change how the wound responds. The treating clinician decides whether and when to refer. If a referral is made, Gateway can help send records, arrange transportation and get the results back to the wound care team.
Why would a clinician leave a dry, dark scab alone?
On a foot or toe with poor blood flow, a dry, firmly attached covering can act as a natural barrier. Removing it may leave a larger open wound that the limb cannot heal. Clinicians sometimes keep the area dry and protected and watch it closely. Report any softening, drainage, odor or redness at the edges right away.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.