Non healing/ PVD. Non healing foot wounds are a big concern for diabetic patients. If circulation is adequate, then good wound care and offloading is usually successful. If poor circulation is present, then wound healing is difficult. Poor abis under .5-.6, makes healing difficult. A vascular consult, if you are concerned, is always a good idea. "if you don't have good irrigation, you won't have a good crop" dr l.
Many. There are many guidelines to send a patient to a vascular surgeon but the main one is not being able to feel pulses in the foot, or a non-healing sore of the foot.
Non-invasive studies. A set of noninvasive vascular studies should be ordered. Anyone with symptoms of claudication, pain at rest, non healing ulcers and gangrene along with abi/tbi less than 0.9 , pulse volume recordings that are less than normal, segmental pressure measurements with a greater than 30-40mmhg difference between segments. Doppler waveforms less than tri-phasic. Pvd = CAD so assess both.
Pulses, ABIs. Among other warning signs, i'll refer a patient to a vascular surgeon if i cannot adequately feel their pulses in their feet and ankles, or if they have an abnormal abi (a test that shows how much blood flow is getting to your feet and toes), or if they have a wound that appears to have been caused or worsened by lack of blood flow.