What are the recommended treatment options for managing arterial ulcers in a primary care setting?

Treatment options for managing arterial ulcers in a primary care setting include:

• Urgent referral: Refer patients with arterial ulcers, especially those with chronic limb-threatening ischaemia, urgently to a vascular multidisciplinary team for assessment and management, as revascularisation may be required ²,⁴.
• Pain management: Offer analgesia such as paracetamol and opioids depending on pain severity, with consideration of neuropathic pain treatments if present ².
• Wound care: Maintain cleanliness of the ulcer, avoid strict aseptic technique but prevent cross-infection, and use appropriate dressings that are non-adherent and suited to the wound characteristics; debridement may be considered if necrotic tissue is present but should be done by trained professionals ¹,³.
• Secondary prevention and risk factor management: Address cardiovascular risk factors including smoking cessation, diabetes control, lipid management, blood pressure control, and encourage exercise to prevent disease progression ²,⁴.
• Patient education: Provide tailored information about the condition, risks, treatment options, foot care, and lifestyle modifications to support shared decision-making and self-care ²,⁴.
• Compression therapy: Generally contraindicated in pure arterial ulcers due to risk of worsening ischaemia; thus, compression should be avoided unless mixed aetiology is confirmed and managed by specialists ¹.

In summary, primary care management focuses on initial wound care, pain control, risk factor modification, patient education, and prompt referral to vascular specialists for further assessment and possible revascularisation ¹,²,⁴.