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Elliot Health System is a non-profit organization serving your healthcare needs since 1890.
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The Center for Wound Care and Hyperbaric Medicine

Elliot at River's Edge
185 Queen City Avenue
Manchester, NH 03103

Phone: 603-663-3630
Fax: 603-663-3669

Hours: Monday-Friday, 7:30 am – 4:30 pm

Patient Education

Arterial Ulcer

Ulcers of the legs and feet can be caused by many reasons. One of these reasons is poor circulation. People at higher risk for this problem include those older than 70, ages 50 to 69 in a person who has smoked or has diabetes, and ages 40 to 49 with diabetes and artery disease known as atherosclerosis in other areas of the circulation according to the The American College of Cardiology (ACC) and the American Heart Association (AHA). Symptoms of poor leg circulation include calf cramping with walking that improves with rest and foot pain when legs are raised. Arterial ulcers can be challenging to heal, as the body needs blood flow to the wound.

Description: People with poor circulation in their legs often have shiny, tight, hairless skin over the legs. They may notice that their feet or toes become darkened with purple discoloration when the feet are down, and then turn pale when the feet are raised. Ulcers of the legs, feet or toes can be caused from poor blood flow of the arteries bringing blood away from the heart to the feet. These ulcers are usually quite painful. The ulcers are often dry, with a punched-out look, and are difficult for you to heal without assistance. People with poor circulation often experience pain in the lower legs with walking and pain in the feet when in bed or when feet are elevated. These are signs that your feet and lower legs are not getting enough oxygen. The most common sites of the ulcers include toes, ankles and shins but can be located anywhere on the lower legs and feet. They often begin as small wounds caused by minor trauma that are unable to heal or worsen because of lack of blood supply.

What to expect: In the Wound Center, the pulses in your feet will be assessed. In addition, your blood pressure will be taken in your lower legs and then compared to the blood pressure in your arms to provide information about your blood flow to your feet. Further testing may be needed. Your wound care team will decide on the proper treatment to speed wound healing, and will assist you in your wound care plan.

How you can help your wound healing: While most wounds of the legs and feet heal faster with rest and with elevating your legs, arterial wounds improve with simple frequent foot and ankle exercises to to improve the circulation to your feet and lower legs. Gravity also helps to improve your blood flow. Placing the head of your bed on blocks, safely, helps to decrease foot pain at night. Avoid elevating your legs, keeping legs in a lowered position when possible.

Diabetic Ulcer

In 2011, the National Institute of Health reported approximately 3 million Americans have diabetes. Of these, 6% are experiencing a diabetic foot ulcer. The effect of diabetes on the body creates high risk for developing a foot or heel ulcer. Elevated blood sugars caused by diabetes can decrease feeling in the foot, reduce circulation, decrease the amount of natural oils and sweat and change bone structure in the feet. All of these factors increase the risk of foot ulcer development. In addition, high blood sugars increase the risk of infection in a foot ulcer, a common diabetic foot ulcer complication. With prompt treatment and important prevention, foot ulcers can be healed and avoided.

Description: Diabetic foot ulcers are most commonly found on the bottom of the foot or heel, although can be anywhere on the foot. The ulcers often begin as blisters or cracks in the feet. Sometimes a wound occurs with nail or callus trimming, stepping on an object, or other cause of injury. Slow healing, redness, swelling pain, fever or drainage are all signs that need prompt attention. It is best not to wait until worsening symptoms occur, but to seek treatment as soon as possible. The earlier the treatment, the shorter the time to heal, in most every case. In fact, the longer a foot ulcer is present, the more difficult it is to heal and the higher the risk for complications.

What to expect: Your concerns are our priority. You can expect to be an active member in your wound healing team. Your feet will be examined for sensation, blood flow, signs of infection, bone deformities and wound assessment. Additional testing may be ordered as needed. Focus will be on cleaning your wound thoroughly, treatments that range from ointments and dressings to grafting, and reducing pressure on the foot. We understand that your ulcer is impacting your day to day life, so we strive to find ways to assist you in reducing the effects of your ulcer and the treatments on your life.

How you can help your wound healing: Keeping your blood sugar at your target level will help your wound to heal. Blood sugars over 150 have been shown to significantly slow wound healing. Inspecting your feet and ulcer daily is important. Notifying the wound center staff of any concerns promptly will help us to better treat your ulcer and improve wound healing. If you are advised to minimize pressure on your ulcer, following this plan to the best of your ability will help your ulcer to heal. We encourage you to ask questions and let us know your concerns throughout your wound healing experience.

Venous Leg Ulcer

The majority, an estimated 80%, of all leg ulcers are caused by problems with the venous system that returns blood to the heart. Several factors may contribute to venous disease. These include having had blood clots in your legs in the past, being of older age, having family members with similar problems, past pregnancies, being overweight, and having had a job that requires long periods of time standing.

Description: Those with venous leg ulcers often experience leg swelling, aching, lower leg itching rash and skin discoloration. Leg pain and swelling are often reduced with elevation. Leg ulcers can leak fluid, which does not always indicate infection. The ulcers may develop spontaneously, or may start as a small wound from minor trauma. These ulcers can be tough to heal without help, and often linger for months to even years without proper treatment. Studies consistently show that getting treatment promptly shortens the time of healing, so it is best not to wait. Infection can be a complication of a venous leg ulcer. Symptoms of infection include redness, swelling, fever, chills, increase in pain, and thick drainage. Infection slows wound healing and requires prompt treatment. Once healed, it is common to have ulcers recur without proper treatment.

What to expect: It is important for you to know that at the Wound Center we recognize the pain and inconvenience you have been experiencing can be frustrating. We take your wound healing seriously, and focus on both a thorough assessment and effective, proven treatments. We will ask you questions to give us information about your ulcer and how it has been affecting you. Your ulcer, feet and lower legs will be assessed. Additional testing with ultrasound may be ordered. Typically you will be asked to come in weekly for treatments until your ulcer is healed. After healing, you will be assisted in prevention of the recurrence of your ulcer. After all, an ounce of prevention is worth a pound of cure!

How you can help your wound healing: Leg swelling slows your ulcer healing. There are ways you can reduce your leg swelling. Avoid long periods of standing, sitting with legs dangling or crossed. Walking will improve circulation and reduce leg swelling. If you are able, walk short distances several times a day. When sitting, elevate your lower legs. If you need to stand for a length of time, it helps to move your legs, for example, walking in place.


Lymphedema causes significant swelling in the lower legs or arms which often causes difficulty in walking and moving. Fluid is usually moved throughout the body in the lymph system. In lymphedema, the lymph system may not be functioning properly, leading to a build-up of fluid in the feet, ankles, legs, lower abdomen or arms. This swelling can be one sided or affect both sides, but often affects one side more than the other. A faulty lymph system is often genetic, but can be caused by surgery, by faulty veins, or can be caused by a parasitic infection common in poorer countries, but quite rare in the United States. Leg ulcers are not a common symptom of lymphedema, but can occur. Patients with lymphedema are at higher risk for wound and recurrent skin infections which can become serious. Management of the lymphedema condition is very important in overall health.

Description: Lymphedema develops and worsens over time. The long term effects of limb swelling causes changes to the shape of the leg or arm and changes to the skin. You may notice the skin is thicker, darkens, and develops small bumps.

What to expect: At the Wound Center we recognize the difficulty caused by having lymphedema. Our goal is to assist you in reducing your swelling, to improve you pain, mobility and quality of life. You can expect to be seen at the Wound Center 1-2 times per a week initially, which may decrease in time. We may also enlist the help of physical therapists in massaging and wrapping the limb.

How you can help your wound healing: Lymphedema management requires intensive therapy to move fluid and decrease the swelling of legs or arms. Patients most often find that their quality of life is significantly improved with therapy. Walking becomes much easier after swelling is improved. The number of times you need to be in the hospital for infections is greatly reduced with well managed lymphedema. You can best assist in your care by keeping wraps in place and elevating legs when seated.

Pressure Ulcers

Pressure on the skin, especially over areas of bone, causes damage to the skin that may develop to a pressure ulcer. People with limits to their ability to feel and move are at highest risk for developing a pressure ulcer. Patients with paralysis due to stroke, spinal cord injury, or other severe illness or injury have the highest incidence of pressure ulcer. Unfortunately, these ulcers can become infected and cause severe illness. It is important to heal pressure ulcers quickly, and develop a plan to avoid future ulcers.

Description: Pressure ulcers begin as an area of redness or bruising that eventually blisters or causes a break in the skin. This discoloration occurs as small blood vessels called capillaries are crushed between bone and the outside surfaces. Pressure ulcers occur over areas of bone or develop under an object such as a foley catheter or other medical device. Initially the wound may appear as insignificant, however, the damage to the underlying tissue may be more than you realize. It is not uncommon for small pressure wounds to develop into bigger problems quickly. Therefore, it is crucial that you seek help as soon as you notice a problem with your skin. The sooner help is provided, the more likely you can avoid complications.

What to expect: The wound care team recognizes the challenges your wound causes in your daily life. We will work with you to find the most effective, state of the art wound healing plan that fits your individual needs. Every person with a wound is different, as is every wound. We will look at not only your wound but discuss with you how your daily habits either improve or hinder your wound healing, and assist you in creating a wound management plan. We will assist you in obtaining the off-loading devices that work for you, as well as arrange wound care in the home if you desire. Specialty shoes, cushions and mattresses can play a significant role in wound healing.

How you can help your wound healing: The most important factor in healing is avoiding continued pressure. The pressure that caused the wound needs to be removed to allow for wound healing and to avoid re-opening of the wound once healed. Specialty mattress and cushions are crucial in reducing pressure from the wound. However, even the most effective cushions do not take pressure off completely. It is very important to change positions to relieve pressure, in addition to the use of cushions and special mattresses. When seated, it is important to shift weight every 15 minutes to improve blood flow. It is also important to move your overall position every two hours. Nutrition is also a crucial factor in wound healing. Those with a pressure ulcer require an increase in protein intake for wound healing. Eating foods rich in proteins, for example, yogurt, eggs, fish and lean meats, will help to heal your wounds. Most importantly, sharing your experience with your wound team will better help us to develop a plan that fits into your daily life.

For all appointments please call 603-663-3630