The occurrence of an ulcer of arterial origin evidence the existence of severe ischemia which may lead to a mutation.
The arterial lesions are usually localized at the axis of femoral-popliteal and leg arteries. So to the clinical examination the femoral pulse is generally well perceived and pulse not found downstream.
We must differentiate between ulcers of the forefoot that once the bypass performed at worst lead to amputation limited type trans-metatarsal ulcers of the hindfoot.



Indeed the calcaneal pressure sores occurring on arteritis is always very difficult to heal even after bypass surgery because the bone is quickly exposed. It is therefore an urgent treatment.
Angiography performed under any neuroleptic analgesia allows for the assessment of the lesions. In the rare cases where the arterial lesions are limited, treatment with endoluminal dilatation is indicated (associated with surgical debridement of the ulcer). In other cases, revascularization may require bypass femoro-popliteal, femoral-tibial artery or on foot.



The best hardware bypass is considered the saphenous vein by Doppler evaluation before surgery. veins of the arm can also be used where the need for all blood samples in the level of the clock to avoid damaging the equipment vein. If there is no hardware or venous whether brief intervention is needed bypass surgery is performed using a prosthesis with the medium-term results are however lower.
Distal bypass surgery are a little aggressive, subcutaneous, performed under spinal anesthesia, low mortality. The lift is permitted on the following day. This means that age is not an indication-cons.
In rare cases, arterial lesions are located upstairs with aorto-iliac loss of femoral pulse. The lesions fall short of the expansion. Other lesions are aortofemoral bypass or bypasses said “extra-anatomic” bypass type subcutaneous axillary-femoral or femoro-femoral, they are feasible even in elderly or cardiac function limit.
Despite the gestures of arterial revascularization who have treated the cause of the ulcer, some wounds can heal spontaneously and will require treatment of plastic surgery. The local reconstruction is tailored to the characteristics of the ulcer and the state after local arterial revascularization:

  • Skin grafts are indicated to treat ulcers extensive superficial and well vascularized after bypass surgery, they can “shunt” phase of epithelialization and significantly shorten the healing time.
  • The flaps (providing vascularized tissue by means of a vascular pedicle) are the treatment of choice for ulcers or poorly vascularized exposing fragile structures (tendons, cartilage, bone, blood vessels or prostheses).
  • Pedicled flaps are taken next to the ulcer if there are visible vascular pedicles to control angiography in bypass.
  • The free flaps are collected remotely and revascularized in situ, when the above conditions are not met (lack of nourishing pedicle flap locally and / or extensive ulcer).

Gestures of plastic surgery may be necessary to cover bridging exposed thereby preventing their rupture.

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