Vascular Disease and Wound Healing

The Two Main Types: Arterial vs. Venous Wounds

All vascular wounds are linked to poor circulation, but not all are the same. Most fall into one of two main categories—arterial wounds or venous wounds—depending on which part of the circulatory system is affected.

Arterial wounds develop when blood can’t flow to the lower legs and feet due to narrowed or blocked arteries. In contrast, venous wounds occur when blood has trouble flowing back up from the legs to the heart, typically due to weakened or damaged veins.

Understanding which type of wound you have is essential. Because they have different causes, locations, and symptoms, they also require different treatments. A correct diagnosis ensures you get the care that’s most effective for your specific condition.

In the following sections, we’ll break down each type in more detail—starting with arterial wounds and followed by venous wounds—so you can better understand what’s happening in your body and what to expect in terms of care.

Arterial Wounds: Caused by Poor Blood Flow TO the Legs

Arterial wounds happen when blood can’t reach certain areas of the body—usually the lower legs and feet—due to blocked or narrowed arteries. Arteries carry oxygen-rich blood from the heart to the rest of the body, and when they’re damaged, they can’t deliver enough oxygen and nutrients to keep tissue healthy.

Over time, this reduces or stops blood flow to the legs and feet. When tissues don’t get enough oxygen, they become ischemic, meaning they are starved of blood. Without oxygen, the tissue begins to break down and die, which can lead to painful open sores known as arterial ulcers.

Here’s how to recognize arterial wounds:

Location

• Often found on the heels, tips of the toes, between the toes, or over bony areas that rub against shoes or hard surfaces.

Appearance

• Typically have a “punched-out” look with well-defined borders

• The base of the wound may look pale, gray, or black, showing little to no tissue growth

• Minimal bleeding and often very dry

Associated Symptoms

• Skin may feel cool to the touch

• Legs may appear shiny, thin, and hairless due to poor circulation

• Severe pain, especially when lying down or elevating the legs, is common—this is known as rest pain

If you’re experiencing these symptoms or have a wound that won’t heal, it’s essential to seek medical attention. Without proper treatment, arterial wounds can worsen quickly. In the next section, we’ll explore venous wounds, which occur when blood struggles to return from the legs.

Venous Wounds: Caused by Poor Blood Flow FROM  the Legs

Venous wounds are the most common type of leg ulcer and result from problems in the veins of the legs. Usually, leg veins have one-way valves that help push blood back up to the heart. When these valves become damaged or weak, blood starts to pool in the lower legs instead of circulating properly.

This blood pooling increases pressure inside the veins, causing fluid to leak into surrounding tissues. Over time, this leads to swelling (edema), which damages the skin and hinders the delivery of nutrients and oxygen to the tissue. The constant pressure and fluid buildup eventually cause the skin to break down, leading to the development of venous ulcers.

Here’s how to recognize venous wounds:

Location

• Most often found on the lower leg, especially between the knee and ankle

• Commonly appears on the inner leg, just above the ankle (called the medial gaiter area)

Appearance

• Typically shallow wounds with irregular, uneven borders

• Wound base is often red and may be covered with yellow, fibrous tissue

• Usually produces moderate to heavy drainage due to persistent swelling

Associated Symptoms

• Reddish-brown skin discoloration (known as hemosiderin staining) from leaking blood cells

• Skin may become thickened, dry, and hardened (a condition called lipodermatosclerosis)

• Swelling that worsens throughout the day, often accompanied by aching, heaviness, or fatigue in the legs

Venous wounds tend to develop slowly and can persist without proper care. Compression therapy and elevation are key components of treatment, along with wound care to manage drainage and prevent infection. Identifying the signs early can make a big difference in healing time and comfort.

Other Conditions That Complicate Healing

While arterial and venous diseases are common causes of vascular wounds, other health conditions can also affect the body’s ability to heal properly. These conditions may damage blood vessels or interfere with the body’s response to injury, leading to delayed or impaired wound healing.

People with these additional health issues are often at greater risk of developing chronic wounds. Their bodies may not deliver enough oxygen and nutrients to the damaged tissue, or they may have a reduced immune response, making it harder to fight infections and repair the skin.

In the next sections, we’ll look at two specific conditions that can slow healing and increase the risk of complications. Understanding these risk factors is important for managing wounds and improving recovery.

Inflammatory Diseases like Rheumatoid Arthritis

Chronic inflammatory diseases, such as rheumatoid arthritis (RA), can significantly impact the body’s ability to heal wounds, especially when blood vessels are involved. One of the key complications of RA is a condition called vasculitis, which refers to inflammation of the blood vessels.

When vasculitis occurs, the walls of the blood vessels become damaged and narrowed. This limits the flow of blood to surrounding tissues, reducing the oxygen and nutrients needed for healing. Over time, this restricted blood flow can lead to the development of skin ulcers or vascular lesions, particularly on the lower legs or around the joints.

These wounds are often difficult to heal because the underlying inflammation continues to interfere with circulation and tissue repair. Managing the primary inflammatory condition is a crucial step in promoting healing and preventing further complications. Understanding the link between diseases like RA and vascular wounds helps guide more effective treatment and care.

Diabetes and Its Impact on Vascular Health

Diabetes plays a major role in both poor circulation and delayed wound healing, making it a significant risk factor for chronic wounds.

It affects the body in two key ways that together create a dangerous combination for skin and tissue health.

First, diabetes accelerates atherosclerosis, the buildup of plaque in the arteries, which can lead to or worsen peripheral artery disease (PAD). This reduces blood flow to the limbs, especially the feet and lower legs, limiting the oxygen and nutrients needed for wounds to heal properly.

Second, diabetes often causes nerve damage, known as neuropathy, which reduces feeling in the feet. As a result, people with diabetes may not notice small cuts, blisters, or pressure injuries. These unnoticed wounds can become infected or develop into serious ulcers before they’re detected.

Together, poor circulation and reduced sensation increase the risk of slow-healing or unnoticed wounds that may lead to complications. That’s why regular foot care and blood sugar management are essential parts of wound prevention and overall vascular health in people with diabetes.

Diagnosis and Advanced Vascular Treatments

Effective treatment of vascular wounds begins with an accurate diagnosis. Because different types of wounds—such as those caused by arterial, venous, or other conditions—require different care strategies, identifying the root cause is critical. Wound care specialists use a combination of physical examinations and non-invasive tests to assess blood flow, check for signs of infection, and determine the underlying circulatory problems contributing to poor healing.

Once the cause is identified, treatment focuses on three main goals:

1. Managing the underlying circulatory issue

1. Improving blood flow to support healing

1. Providing advanced wound care to protect and regenerate tissue

Specific treatments vary depending on the condition. For venous ulcers, compression therapy helps reduce swelling (edema) and improve circulation. For arterial ulcers, procedures to restore blood flow, such as angioplasty or bypass surgery, may be necessary. In patients with diabetes, careful blood sugar control and nerve monitoring are essential to prevent further complications.

Advanced wound care techniques, including specialized dressings, growth factor treatments, and negative pressure wound therapy, can help protect the wound and promote tissue regeneration. With the right combination of medical care and ongoing monitoring, many patients experience significant improvement and a return to better health. The good news is that effective, personalized treatment options are available—and they can make a real difference.

How to Find a Wound Care Center® Near You

If you or a loved one is struggling with a wound that won’t heal, a Healogics Wound Care Center can help. Since there is no need for a referral, your treatment is only a click and call away.