When considering procedures of the foot and ankle, peripheral arterial disease is not the only vascular condition to impact a successful outcome.
Venous insufficiency is a chronic disease that over time will cause poor wound healing secondary to inflammation of the skin and subcutaneous tissue. Venous pathology develops when venous pressure is increased and return of blood is impaired. This can result from valvular dysfunction of the deep, superficial or perforator veins , venous obstruction, or a combination of these.
These factors are exacerbated by calf muscle pump dysfunction following surgery. This produces venous hypertension, particularly with standing or ambulation. This contributes to alterations within the small blood vessels and may result in poor surgical wound healing.
When a surgical wound is created in this patient population, it may be the prelude to a chronic wound. The peri-operative management of chronic venous edema and lymphedema utilizing elastic and non-elastic compression therapies may improve post-operative wound healing. However, pre-operative evaluation and intervention may improve healing and relief from symptoms associated with chronic swelling leading to increased patient satisfaction and lower surgical morbidity.
