Vascular ulcerations can be related to blood flow coming into the foot and also blood flow leaving the foot. When a foot ulcer is related to a lack of circulation this is called an ischemic. The body requires Adequate oxygen to heal the ulcers wet in ischemic situations there is a lack of blood. This is seen with Smokers, diabetics, and patients have peripheral arterial disease. Treating these ulcers requires a multi- disciplinary plan. With being and the community for over a decade we have established relationships with vascular surgeons and Interventional cardiologists and patients can be seen within 3 days.

Patients also require adequate and appropriate dressing changes that can be done at home by 1 self or we can schedule home care. Offloading the ulcerations is also important and we are able to dispense in the clinic appropriate shoes, crutches, and knee scooters. At times the ulcer may be infected and we are able to prescribe the adequate antibiotics, take cultures or have patients be seen by infectious disease in a reasonable time frame. We are able to dispense wound care dressing and also will perform noninvasive treatments in the office setting or if needed formal surgery in the operating room at 3 different hospitals.

We have started to use a modality called ultramist that is assisting to increase oxygen to the wound temporarily and increase granulation tissue, with a simple not painful office visit. However at times with ischemic ulcerations wounds may be infected, gangrene, require amputation. We work with vascular or Interventional Cardiology to assess healing potential and amputate as little as possible to allow healing and patients to return back to their active daily living.

Neuropathic ulcerations are typically seen in diabetics however can also develop with Charcot-Marie-tooth, paralyzed, and patient with history of alcoholism. Neuropathic ulcerations are difficult to heal as patients are not aware of the damage they are creating with walking on the foot as patient’s pain responses are not present. Detailed education and appropriate how offloading of the ulcers are key. We have the ability to place patient in an offloading device, placing total contact casts (TCC), performing an office debridement, dispensing wound care supplies all in a single visit With us being a prior practice we do not have the additional cost of a facility fee like wound care centers, and are able to see patient within 24-48 hours. We have noticed the sooner these ulcerations are addressed the less likely amputations or admission to the hospital is required.

We see these ulcerations typically in the heel called decubitus ulcerations. These ulcers are easily preventable with offloading. This can be done with a simple suspension boot when a patient is at rest and lying in a bed. A more typical we see is when patients have a structural deformity like Charcot. We are trained and are able to create custom boots and orthotics to offload these deformities. Would like to prevent these sores and recognize them with preventative foot care which we provide. Diabetic shoes when patients have neuropathy and pre ulcerative callus qualify for these devices and are essential in preventing these types of ulcers. However when the ulcers do occur or we are able to address it in the office effectively and efficiently.

These ulcers are seen in many different Fashions. This can be seen with temperature burns; lacerations, open fractures, motor vehicle accidents, and gunshot wounds. These ulcerations are very difficult to treat, most will become infected, can be painful if the patient is not neuropathy, some require hospitalization and others require amputation.

In our office we are able to address most of the traumatic ulcers however if you are admitted into the hospital (Chelsea, Henry Ford Allegiance hospital, or Hickman hospital) ask your internist to consult us To address these injuries and obtain inpatient consultation by us. Once again the central treatments of an infection control, blood flow circulation, wound care and debridement, offloading and dressing, pain control, and appropriate follow-up are the central aspects to heal these wounds.