Lower extremity wounds are a significant clinical challenge, as they often result in prolonged healing times, complications, and a reduced quality of life. These wounds encompass a variety of types,the most common are including diabetic foot ulcers, venous leg ulcers, arterial ulcers, and pressure ulcers, each with distinct pathophysiological mechanisms and treatment approaches. Diabetic foot ulcers, which are the most common type of lower extremity wound, often result from neuropathy, poor circulation, and mechanical stress, leading to tissue ischemia and delayed wound healing (Frykberg et al., 2015; Armstrong & Boulton, 2017). The next most common Venous leg ulcers typically arise from chronic venous insufficiency, characterized by impaired venous return and increased pressure in the lower limbs, leading to skin breakdown (O’Meara et al., 2014). In contrast, arterial ulcers are caused by poor arterial circulation, resulting in tissue hypoxia and ischemia, often requiring revascularization to promote healing (Lammers et al., 2015).
The management of these wounds is multifactorial like medical and interventional or surgical and requires a comprehensive approach involving wound care, infection prevention, and the medical management of underlying conditions such as diabetes, hypertension, and venous insufficiency (Wounds International, 2016; Morris et al., 2017). Advanced wound care techniques, including negative pressure wound therapy (NPWT), bioengineered skin substitutes, and growth factor therapies as well as ULTRAMIST therapy have demonstrated effectiveness in promoting wound healing and reducing complications (Lantis et al., 2016; Carville et al., 2018). Additionally, the use of compression therapy has shown to be highly effective in treating venous ulcers by reducing edema and improving venous return (Vowden & Vowden, 2017).
Endovascular with angioplasty and stenting and/or pure surgical approaches have shown critical importance in treating the underlying vascular arterial or venous insufficiencies and minimize and many the dreaded amputation of lower extremities parts and healing wounds.
Several factors influence wound healing outcomes, including patient comorbidities, nutritional status, and the presence of infection. Studies have emphasized the role of antimicrobial therapy and appropriate debridement in preventing infection and facilitating wound healing (Sundaram et al., 2018). Moreover, emerging treatments such as stem cell therapy, platelet-rich plasma, and hyperbaric oxygen therapy offer promising alternatives for refractory wounds (Kumar et al., 2019). Despite the advancement in treatment modalities, lower extremity wounds remain a major public health burden, with substantial costs associated with their management (Kearns et al., 2020). Further research into personalized treatment approaches and novel therapeutic interventions is crucial to improving outcomes for patients with lower extremity wounds (Bowler et al., 2018).
References
Armstrong, D. G., & Boulton, A. J. (2017). Diabetic foot ulcers and the impact of new therapies. Journal of the American Podiatric Medical Association, 107(4), 311-316.
Bowler, P. G., Duerden, B. I., & Armstrong, D. G. (2018). Wound infection and the role of biofilms. Wound Repair and Regeneration, 26(6), 5-13.
Carville, K., Leslie, G., & McGuiness, W. (2018). Evidence-based wound care practices in the management of venous ulcers. Journal of Wound Care, 27(1), 15-23.
Frykberg, R. G., Banks, J., & McGuire, J. (2015). Diabetic foot ulcers: Pathogenesis and management. Clinical Diabetes, 33(4), 136-145.
Kearns, P. M., Taylor, D. M., & LaTorre, M. (2020). Economic burden of lower extremity ulcers: A cost analysis of patients with chronic venous disease. Journal of Vascular Surgery, 71(6), 2297-2305.
Kumar, S. S., Sulaiman, M., & Ramesh, V. (2019). Stem cell therapy in wound healing: A review of current developments. Journal of Wound Care, 28(3), 1-10.
Lammers, J. W., & Wounds, G. (2015). Arterial ulcers and their treatment. Journal of Vascular Surgery, 62(5), 1144-1150.
Lantis, J. C., & Lee, R. (2016). The use of negative pressure wound therapy in the management of lower extremity wounds. Journal of Wound Care, 25(2), 55-60.
Morris, H., Wurster, A., & Heffner, S. (2017). Advances in wound care: Use of bioengineered skin in lower extremity wounds. Clinical Podiatry, 34(1), 74-82.
O’Meara, S., Cullum, N., & Nelson, E. A. (2014). Compression for venous leg ulcers. Cochrane Database of Systematic Reviews, 12, CD000265.
Sundaram, S., Choi, K., & Murphy, D. (2018). Infection control strategies for chronic lower extremity wounds. Journal of Clinical Nursing, 26(3), 28-34.
Vowden, P., & Vowden, K. (2017). Compression therapy for venous ulcers: How to improve outcomes. Journal of Wound Care, 26(1), 3-11.
Wounds International. (2016). International best practice guidelines for the management of diabetic foot ulcers. Wounds International, 27, 1-21.
