Non-Healing Wound Care in Sarasota & Bradenton

A Wound That Won’t Heal Is a Circulation Problem Until Proven Otherwise.

Healthy skin heals. When a wound on the leg or foot has been open for more than a few weeks, something is interfering — and in many cases that something is blood flow. Either not enough blood is arriving to supply the tissue with oxygen, or blood is not leaving properly and is pooling under pressure in the leg. Both are vascular problems, and both are potentially treatable.

This is where many patients lose time. A wound gets dressed, then dressed again, then dressed differently, sometimes for months, without anyone examining the circulation underneath it. Dressings and antibiotics manage a wound. They do not fix the reason it is there.

Dr. Ulloa is a Certified Wound Specialist Physician in addition to being a board-certified vascular surgeon, which means the evaluation and the treatment happen in the same place. We assess the wound, test the circulation, identify the cause, and — whether the cause is arterial or venous — we can correct it ourselves rather than referring you onward and starting over.

Wounds We Treat

• Venous leg ulcers — typically near the ankle, often with surrounding brown discoloration and swelling
• Arterial and ischemic ulcers — usually on the toes, heel, or outer ankle, often painful, caused by poor arterial inflow
• Diabetic foot ulcers, including those under the ball of the foot or heel where sensation has been lost
• Wounds that have failed to heal after surgery
• Pressure injuries on the heel or ankle
• Any leg or foot wound that has not closed within four to six weeks

Finding the Cause

The first visit is a diagnostic visit. We examine the wound and the limb, then test circulation directly. That testing usually includes an ankle-brachial index comparing blood pressure at the ankle against the arm, toe pressures when arteries are calcified and the ankle reading cannot be trusted, and a duplex ultrasound to look at both arterial inflow and venous reflux. We also assess for infection, for bone involvement, for pressure and footwear problems, and for the loss of protective sensation that lets a small injury become a large one before it is noticed.

That evaluation determines everything that follows. A venous ulcer and an arterial ulcer can sit inches apart on the same leg and require opposite treatment — compression helps one and can harm the other. Getting the diagnosis right first is not a formality.

Treating the Cause, Not Just the Wound

For venous ulcers, the standard of care is compression therapy — and there is strong evidence that treating the underlying vein reflux early, rather than waiting for the wound to close first, heals wounds faster. In a randomized trial of 450 patients with venous leg ulcers, those who had their superficial vein reflux treated within two weeks healed in a median of 56 days, compared with 82 days for those whose vein treatment was deferred. At 24 weeks, 85.6 percent of the early-treatment group had healed, against 76.3 percent of the deferred group. The trial also found that early treatment increased the amount of ulcer-free time patients had over the following year.

That is why a vein evaluation is part of wound care here rather than something considered afterward. If reflux is driving the ulcer, closing the vein is treatment for the wound.

For arterial and ischemic wounds, the priority is restoring blood flow. Without adequate circulation, no dressing, no antibiotic, and no advanced product will close the wound. Where the arteries can be reopened or bypassed, that is done first — and that work is covered in detail on our limb salvage page.

Alongside correcting the circulation, ongoing wound care includes debridement to remove dead tissue, dressings matched to the wound and changed as it evolves, offloading and appropriate footwear for foot wounds, infection control, and management of blood sugar, nutrition, and swelling. These matter — but they work when the circulation underneath them is right.