To treat patients with lower extremity ulcers, you need to find out if there’s impaired arterial blood flow. For some patients, however, the standard Ankle Brachial Index (ABI) yields misleading results. Fortunately, there’s an easy alternative: the Toe Brachial Pressure Index (TBPI). Here’s when and how to perform this simple test.
By Christopher Miles, OT, CLT, CWCA, medi USA
Unfortunately, when patients think of compression garments they think of socks that are too tight and difficult to get on, or tend to roll and pinch. What they might not be thinking is that compression therapy is practically the only medical treatment likely to reduce the rate of recurrence of their nasty, painful and smelly venous leg ulcers.
Your patient has a lower extremity wound. You aren’t sure what exactly you are dealing with. You know you need to measure the ankle-brachial index (ABI), but as you wait for results, some of your wound assessment findings offer clues.
Let’s start with the venous ulcer, typically found on the medial lower leg, medial malleolus and superior to the medial malleolus. Seldom will you see them on the foot or above the knee. They tend to be irregular in shape, are superficial, have a red wound bed, have moderate to heavy amount of exudate and the patient may have no pain or a moderate level of pain. Surrounding skin can be warm to the touch, edematous, scaly, weepy and you may see hemosiderin staining present. An ABI provides a definitive answer and will come back at 0.9.
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