Lower extremities: the big three

Some of the most problematic, chronic, and recalcitrant wounds are found on the lower extremities of our patients. The most common of these is what I call ‘the big three’: venous, arterial and diabetic wounds.

It never fails when I am talking with fellow wound clinicians about their biggest challenges, they always indicate one of ‘the big three’ as being the most stubborn or difficult wound they are trying to heal. I have heard numerous patients with venous leg ulcers comment,

‘I have had this wound for over 3 years… 6 years… or 10 years, nothing works, it's never going to heal’.

Yikes. As a wound care clinician, this is a shake your head, take a deep breath moment. This issue of Wound Central focuses on interventions and treatment strategies for healing these troublesome wounds.

Treatment for any wound begins with an accurate assessment to determine the correct aetiology. Be sure to read ‘differentiating between red legs and cellulitis’ (page 95) and the Apple Core column ‘Lower Extremity Wound Characteristics’ (page 60) for clinical tips to assist in identification of lower extremity wounds. These two articles, and throughout this issue, the term ABI or ankle brachial index is used, and for those readers that are not familiar with this, I encourage you to learn more about the ABI exam, as the ABI is recommended standard of care in all current clinical practice guidelines.¹