Dr. Hoy uses the VIP approach to ulcer care and limb preservation. This stands for vascular, infection, pressure.
Vascular: It is important to make sure there is enough circulation to heal the ulcer or wound. If the patient has poor circulation, the nutrients and healing factors may not be able to get to the wound to heal it. We test the feet to make sure there is adequate circulation, such as checking pulses and getting arterial testing at a local vascular lab. If there is decreased circulation, a referral may be needed to a vascular surgeon to perform procedures to increase circulation.
If there is swelling, that means there is poor vein and lymphatic function and compression is needed to heal the ulcer.
Infection: Infection in the wound impedes wound healing. Topical antibiotics are used to prevent and treat infection. If there is more severe infection, oral antibiotics may be needed. Debridement is performed to take out infected and non-viable tissue in the wound. If there is any infected bone, that may need to be removed as well if antibiotics are not working.
Pressure: There may be areas of increased pressure that prevent wounds from healing. If the ulcer is on the bottom of the foot shoes may be too flexible and keep it from healing. Special offweighting shoes and casts may be needed. The increased pressure may also be caused by deformities such as bunions and hammertoes or bone spurs. Surgical procedures may be needed to reduce these deformities to allow the ulcer to heal.