What tests check blood flow to a wound?

Written by WISH Clinic

Clinically reviewed by Dr. Traci A. Kimball, MD, MBA

Last medical review

An exam comes first: checking pulses, blood pressure in the limb, and listening for a whooshing sound over the artery. Tests include the ankle-brachial index, Doppler ultrasound, and angiography of the legs, including MR or CT angiography.

The first checks are done by hand and with a stethoscope, before any machine is involved. When examining a leg with peripheral artery disease, a provider may find a whooshing sound when the stethoscope is held over the artery (arterial bruits), decreased blood pressure in the affected limb, and weak or absent pulses in the limb. For a diabetic foot ulcer, it’s simpler still: your foot pulses will also be checked.

These are the named tests for PAD: angiography of the legs; blood pressure measured in the arms and legs for comparison (ankle/brachial index, or ABI); Doppler ultrasound exam of an extremity; and magnetic resonance angiography or CT angiography.

The ankle-brachial index is the one most people meet first. It’s simple: blood pressure is measured in the arms and legs so the two can be compared. It needs no needles and no dye.

Checking blood flow is part of what a wound care team does, not something you have to request. Among other things, such a team will examine and measure your wound, check the blood flow in the area around the wound, determine why it’s not healing, and create a treatment plan. That said, if it has not happened, asking is entirely reasonable.

Why it matters so much comes down to one fact: to treat an ischemic ulcer, blood flow to your legs needs to be restored. If blood flow is the problem, dressings are not the answer, and the test result is what separates those two situations.

Which test you should have, and in what order, is a clinical decision made on your own circumstances. What you can take from this is the words to ask whether the blood flow to your wound has been checked, and how.

What to watch for

Contact your provider if you have a leg or foot that becomes cool to the touch, pale, blue, or numb; chest pain or shortness of breath with leg pain; leg pain that does not go away, even when you are not walking or moving (called rest pain); legs that are red, hot, or swollen; new sores or ulcers; or signs of infection (fever, redness, general ill feeling).

This is a question to ask rather than a symptom to watch. At your next appointment, ask whether the blood flow to your wound has been checked, by which test, and when. If the answer is that pulses were felt and nothing further was done, that is still an answer. Write it down with the date, so the next person does not have to start from nothing.

What we look at

  • Whether limb pulses have been assessed and documented
  • Whether an ankle-brachial index has been done, and when
  • Whether a Doppler or angiographic study has been requested
  • Whether the result has reached whoever manages the wound
  • Whether the treatment plan assumes adequate blood flow without evidence of it

Related questions

Sources

  1. MedlinePlus — Peripheral artery disease, legs: https://medlineplus.gov/ency/article/000170.htm
  2. MedlinePlus — Wound care centers: https://medlineplus.gov/ency/patientinstructions/000739.htm
  3. MedlinePlus — Ischemic ulcers, self-care: https://medlineplus.gov/ency/patientinstructions/000742.htm
  4. MedlinePlus — Diabetes, foot ulcers: https://medlineplus.gov/ency/patientinstructions/000077.htm
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