Combinations of risk factors further enhance the likelihood of peripheral ischemia. Cigarette smoking has been noted two and one half times more frequently in diabetic patients with ischemia and gangrene than in patients without diabetes. Even if adequate flow is restored, diabetic control and cessation of smoking are usually necessary for wound healing to occur. There are two different categories of oxygen-deprived wounds. The first is that of distal ischemia, characterized by dry, dead skin and tissue on toes or feet.
Ischemic limbs are particularly vulnerable to pressure related injury.
When wounds are located on ischemic toes, healing is unlikely. The ulcers are often atop bone because there isn't much soft skin tissue in the toes. Toe lesions should be kept dry and clean. Peroxide, while toxic to healing tissue, is useful in decreasing bacterial contamination. Antibiotic ointments may help a little but often cause softening and separation of the tissue.