BEST PRACTICES

How do you distinguish a venous ulcer from an arterial wound? Here’s your guide

Example of lower extremity wound.

Lower extremity wounds can sometimes be tricky to identify, as they have many similarities. Luckily, as you assess these wounds, some key characteristics will stand out making it easier for you to correctly identify them. Though there are several types of lower extremity wounds, the most common are venous ulcers and arterial ulcers.

In this article, we’ll explore the differences among the various lower extremity wounds and offer some key identifying factors to help you efficiently assess their nature.

Venous Ulcers

Example of an Arterial Wound.

Location: Venous leg ulcers usually develop on the inner lower leg, above the medial malleolus, gaiter area.

Size and shape: Wounds are often shallow, but large, and typically have irregular edges that may also slope.

Color: Typically, venous wounds appear ruddy red, with granular tissue. There may also be discoloration with yellow slough present.

Appearance: Surrounding skin may be shiny, warm or scaly. Tunneling is uncommon.

Exudate: These wounds often have a moderate to heavy amount of exudate, causing them to appear “wet.”

Pain level: Individuals often describe a dull, aching pain. This pain is likely more related to venous hypertension and resulting edema rather than from the wound itself.

Other distinguishing characteristics:

  • In the case of infection, there is often an accompanying foul odor, and may be purulent.
  • Venous ulcers are the most common form of lower extremity wound, accounting for 80% – 90% of all leg ulcers.1

Arterial Wounds

Example of a Venous Leg Ulcer.

Location: Arterial wounds occur most often on the foot, in between or at the tips of the toes, at pressure points from foot wear, on the heels and around lateral malleolus (the bone on the outside of the ankle joint).

Size and shape: Most likely round, with a “punched out” appearance. They may range in size from small to large, with well-defined edges.

Color: Often occur yellow, brown or black in color. Skin may also appear pale and non-granulating.

Appearance: Arterial ulcers are often deep, but may also appear shallow in early stages. Skin surrounding the wound is often thin, smooth, taut and dry. Loss of hair on the leg is also common.

Exudate: Unlike venous ulcers, arterial ulcers are often dry due to minimal drainage.

Pain level: Reportedly very painful. Elevating the leg can increase this pain.

Other distinguishing characteristics:

  • Toenails often appear brittle, yellow, deformed, thick and dry.
  • A patient’s pulse may be indistinguishable around the site of the wound.
  • The area around the wound is likely cool or cold to the touch due to minimal blood circulation.