When to Consider a Vascular Evaluation for a Non-Healing Wound

In the Wound Care field, Vascular is your best friend, and I'll tell you why.

Most wounds are expected to move through four predictable stages of healing: hemostasis, inflammation, proliferation, and maturation. In a healthy process, bleeding is quickly controlled, the body clears away damaged tissue, new tissue begins to form, and finally the wound strengthens and closes. When a wound lingers for weeks without progress, stalls in one of these stages, or begins to worsen, it is often a sign that something deeper is interfering with the body’s natural repair system. One of the most common reasons wounds fail to heal is poor circulation, and this is where a vascular evaluation becomes important.

When Healing Stalls

A vascular evaluation should be considered if a wound shows little or no improvement after several weeks of appropriate care. Even when dressings are applied correctly, infection is ruled out, and the wound is protected, a lack of blood flow can prevent healing altogether. Oxygen and nutrients delivered by the blood are the building blocks of recovery, and without them, the wound cannot progress past the inflammatory stage.

Pain as a Warning Sign

Many wounds are uncomfortable, but pain that worsens over time or becomes most noticeable when resting or elevating the leg may suggest arterial disease. In these cases, blood has difficulty reaching the tissues, and the wound is left starved of the oxygen it needs.

Location Matters

The lower legs and feet are especially prone to circulation-related wounds. Swelling, varicose veins, or a history of vascular disease can all point toward poor blood flow as an underlying issue. If the skin around the wound appears shiny, thin, or discolored, or if the tissue looks black or gray, these are important red flags.

Risk Factors That Cannot Be Ignored

Underlying health conditions also increase the chance that poor circulation is to blame. Diabetes, smoking, high blood pressure, high cholesterol, and a history of heart or vascular disease all make a non-healing wound more likely. In many cases, it is only after a wound refuses to heal that circulation problems come to light.

What to Expect From a Vascular Evaluation

A vascular evaluation often includes a physical exam, simple tests like the ankle-brachial index (ABI), and sometimes imaging studies. These tools help identify whether arteries or veins are limiting blood flow. Once identified, treatment may involve medications, compression therapy, or minimally invasive procedures that restore circulation. Taking this step early not only promotes healing but also reduces the risk of infection, hospitalization, and amputation.

Why It Matters

When wounds are not healing, the problem is rarely just on the surface. Without adequate circulation, even the best wound care cannot succeed. A vascular evaluation ensures that the body’s natural repair system has the oxygen and nutrients it needs to move through every stage of healing and finally bring the wound to closure.

Disclaimer: This blog post is for educational purposes only and is not a substitute for medical advice. Always follow the guidance of your healthcare provider and seek medical attention if you have concerns about a non-healing wound.

Written by Dr. Adam Finck, DNP, APRN, FNP-C