“Any break of the skin really is an emergency,” said Dr.Arthurs, who is credentialed in wound care. “The best thing is to get an immediate evaluation.”

During the height of the COVID-19 pandemic, many people with wounds waited to seek treatment from a medical professional, often with a skin break much larger than it was at its conception and at greater risk for a more severe outcome.

“It’s just such a better experience for the patient and for us to get that skin closed when it’s a smaller volume wound,”said Dr. Arthurs.

Particularly for patients with peripheral artery disease, who do not have a healthy arterial and immune system to heal wounds, swift action is imperative – wounds can grow and infections can develop rapidly, even if problems aren’t obvious.The risk of losing a limb for a person with PAD is 1% to 3%,but, once there is a skin break, the risk grows to 30% to 40%.If infection sets in and gangrene develops, the amputation risk climbs to 80% to 90%.

The subtle signs of a body with PAD that struggles to recruit blood supply for wounds are thickened nail beds and dry scaly skin – indicative that not enough blood is reaching the extremities and stimulating oil creation to keep skin healthy and hydrated. Men may notice hair loss from the knee down. More developed signs include trouble walking short distances and pain in the legs caused by restricted blood flow. Insulin resistance, tobacco use, lack of exercise, high stress and diabetes are risk factors for peripheral artery disease and even coronary artery disease.

Diabetes might exacerbate wound development because it can attack nerves, which could lead to neuropathy – when the nerves in the feet no longer are responsive.

“The loss of sensation puts their skin at risk,” said Dr.Arthurs.

The patient might not even notice the wound right away. Combined with restricted blood flow, the sensation in the bones that directs growth and maintains health is reduced, and it’s possible that the person will place weight inappropriately across the foot, causing eroding or pushing bone to wear on the skin.

When a patient with PAD is wounded, blockage in the arteries prevents the wound from receiving blood supply due to imbalanced inflammation in the body and resulting plaque buildup in the arteries. Additionally, diabetes diminishes a healthy immune system, confusing the signals that tell the body to direct repairing cells to the site of the wound.

When people with PAD or diabetes notice a wound, they should go immediately to a wound care center or vascular specialist.

“It’s critical to get in immediately, to get that local wound care,” said Dr. Arthurs, adding that people with healthy immune systems should seek medical care if a would does not heal within three to five days. To treat a wound, Dr. Arthurs works to bring blood flow to the site to stimulate new growth and heal the skin. After initial treatment, the wound is constantly re-evaluated. Patients may need to see a physician weekly for an examination and debridement. Home health nurses may be assigned to help maintain care.

Coastal Vascular & Vein Center, which partners with wound care centers in Charleston, offers walk-in appointments during the week. Addressing a wound early, when it is small, is the “difference in keeping their limb or not,” said Dr. Arthurs. Every centimeter counts.

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