Mixed arterial and venous ulcers

The most common underlying etiologic factors responsible for chronic delayed healing among lower extremity wounds encountered in the outpatient clinic are chronic venous insufficiency (CVI), diabetic neuropathy, and arterial insufficiency (AI). One or more of these fac- tors can be identified in more than 90% of chronic lower extremity ulcers, and treatment protocols have been designed to manage wounds of each type to maximize healing potential. It is important to remem- ber that multiple factors may coexist in any individual patient with a chronic wound, complicating management and hindering the healing process. Recently, it has been reported that the neuroischemic diabetic foot ulcer is now more common than nonischemic neuropathic diabetic foot ulcers, as arterial insufficiency promoted by poorly controlled dia- betes complicates already impaired healing present in patients with diabetes. This article will discuss the management of patients with leg ulcers and both arterial and venous insufficiency, including identifi- cation, diagnostic methods, and treatment protocols to maximize the potential for wound healing.