If your leg ulcer isn’t healing, it may not be the wound care that’s failing — it might be what’s not being addressed. Many chronic wounds don’t heal because of underlying vein or artery problems that haven’t been properly evaluated. Too often, patients spend months getting debridements without ever seeing a vascular specialist. In this post, I explain why that happens, what questions to ask your wound care doctor, and how getting the right referral can finally put you on the path to healing.
When Wound Care Isn’t Enough
Wound care centers do a lot to help the wound itself. They clean it, remove dead tissue, and protect it from infection. These are very important steps. But when a wound doesn’t get better, it’s important to check what’s causing the problem. 60–70% of leg ulcers come from vein problems such as Chronic Venous Insufficiency (CVI). 25-30% of ulcers are due to arterial problems such as Peripheral Arterial Disease (PAD). 10-15% of ulcers are due to Venous and Arterial Mixed disease, or VAM disease, a term I coined to describe ulcers caused by both arterial and venous problems. An ultrasound that evaluates for both arterial and venous disease is a simple study to understand why a wound is slow to close. If the underlying circulation problem isn’t treated, the wound will not heal no matter how well it’s cared for.
Why Referrals Can Be Missed
Sometimes, a referral to a vascular specialist doesn’t happen right away — and it’s not always the fault of the wound care doctor. System factors, insurance rules, or clinic workflows can slow the process. Additionally, some wound centers do not routinely work with vascular specialists and may not fully recognize underlying circulation problems that prevent healing. In communities where vascular specialists are limited, access can also be a challenge. Understanding these factors can help patients advocate for timely evaluation and ensure that the root cause of a wound is addressed.
The Hidden Cost of Repeated Wound Care Visits
Sometimes, chronic wounds seem to linger despite repeated visits and debridements. While most wound centers act in the patient’s best interest, there are rare cases where financial incentives may influence care. Some centers may purposely avoid referring patients to a vascular specialist so they can continue treating the wound without healing it. This can delay recovery and highlights why evaluating the underlying circulation problems is so important.
Chronic wounds affect about 6.7 million people in the U.S. and cost more than $50 billion annually to treat (Healogics, 2019). Repeated treatments without proper evaluation not only delay healing but also add to the overall financial burden, emphasizing the need for a coordinated, team-based approach.
The Role of the Vascular Specialist
A vascular specialist’s main job is to find and treat the underlying circulation problems that prevent wounds from healing. Using simple, noninvasive tests, they can identify issues like chronic venous insufficiency (CVI), peripheral arterial disease (PAD), or VAM disease (venous and arterial mixed). If a problem is found, procedures or treatments can improve blood flow, helping wounds heal faster and lowering the chance of them coming back. Vascular specialists don’t work alone. They collaborate closely with podiatrists, wound care nurses, and other members of the team to address both the wound and its root cause, giving patients the best chance for long-term healing.
What Patients Can Do
From the very first visit, patients should think about asking for a vascular specialist. Ask your wound care doctor: “At what point would I see a vascular specialist?” Ideally, if the wound hasn’t improved in 6–8 weeks, a referral should be made. Without a plan, patients can spend months with little progress. If no plan is offered, it’s okay to seek care elsewhere. Healing a wound takes a team approach — wound care AND vascular care together. Keep notes about how long the wound has been there, how it’s responding to care, and any leg symptoms like swelling, heaviness, pain, or color changes.
Working Together for Healing
A successful wound healing team should include vascular specialists, podiatrists, primary care physicians, and wound care specialists and nurses. Each brings different expertise. Podiatrists are frequently deeply involved in foot and lower leg care and can be key allies in identifying when a wound isn’t healing as expected. Working together as a team ensures patients get the right evaluation and treatment sooner.
Wound care treats the tissue, while vascular care restores the blood flow needed to heal the tissue. Closing the referral gap can turn chronic leg wounds into healed ones. Patients get better faster, doctors feel supported, and the system works better. Healing doesn’t just happen on the surface — it starts from the inside out.
