Peripheral arterial disease (PAD) can reduce wound healing up to 30%. Data from academic hospital-associated wound care centers suggest improvements in wound healing outcomes when wound management is driven by vascular providers. However, whether this benefit is derived solely from early vascular provider involvement remains unclear. A retrospective analysis of 80 patients with arterial disease seen at our institution's wound center between July 2022 and July 2023 was performed. The presence of disease was defined by one or more of the following: (1) prior PAD diagnosis, (2) ankle-brachial index <0.9 or toe pressure <70 mm Hg, or (3) documented absent lower extremity pulses. Patients were divided into two groups: early (<6 week) vascular provider exposure (EVE; n = 45) or late/no vascular involvement (LVE; n = 35). Vascular providers included vascular surgeons and affiliated advanced practitioners. Outcomes were analyzed with the χ2 test, t test, Kaplan-Meier analysis, and Cox regression modeling (variables included if the effect on healing associated with P < .1). Baseline functional status and comorbidity profiles are outlined in Table I. While initial wound sizes were similar, the maximum wound size was significantly larger in the EVE group (P = .002*). Wound ischemia foot infection wound scores (P = .039*) and gangrene were higher in the EVE group on presentation (P = .05*). Although more patients in the LVE group developed imaging-confirmed osteomyelitis (P = .033*), fewer received debridement/amputation (P = .008*). Wounds in the LVE group also took significantly longer to reach maximum size (P < .001*) or checkpoints predicting closure, including 75% wound granulation (P = .05*), 15% size reduction in 1 week (P = .044*), and epithelialization (P = .026*). More wound center visits (P = .024*) and clinic procedures (P = .005*) were required for LVE despite similar surgical provider visits. In addition, LVE had longer times to revascularization (P < .001*) or amputation/debridement (P = .002*) and fewer scheduled intervention after their first surgical provider visit (P = .026*). All the patients in EVE had ankle-brachial indexes performed, with 90.9% of them being performed within 30 days from wound appearance (P < .001*). Although more patients underwent a major amputation in the EVE group (15.6% vs 11.4%), all had documented nonsalvageable limbs before amputation. Healing time trended to be shorter in EVE, but this difference failed to attain statistical significance (P = .089). When controlled for comorbidities, however, healing time was significantly accelerated almost twofold in the EVE group (Table II, P = .032*). Early vascular exposure improves wound healing time, timeliness to intervention, and use of wound center/hospital resources. Further investigation into benefits of vascular involvement within community wound center models could significantly improve awareness and accessibility of arterial wound care in smaller/remote communities.Table IDemographics of wound center patients with arterial insufficiencyDemographicsLate or no vascular provider encounter (n = 35)Early (<6 weeks) vascular provider encounter (n = 45)P valueAge, years71.1 ± 2.466.2 ± 1.9.225BMI, kg/m229.2 ± 1.127.0 ± 1.1.094Sex.795 Male22 (62.9)27 (60.0) Female13 (37.1)18 (40.0)Race.552 White20 (57.1)22 (48.9) Black15 (42.9)22 (48.9) Hispanic0 (0.0)1 (2.2)Ambulatory.736 No6 (17.1)5 (11.1) Assistance17 (48.6)23 (51.1) Full12 (34.3)17 (37.8)Medical/surgical history Smoking history20 (55.6)31 (70.5).168 Diabetes28 (77.8)35 (79.5).848 Hyperlipidemia23 (63.9)32 (72.7).396 Coronary disease20 (55.6)25 (56.8).910 Heart failure9 (25.0)23 (52.3).013 CKD/ESRD12 (33.3)16 (36.4).777 Chronic pain14 (38.9)5 (11.4).004 Prior LE procedureOpen/bypass5 (13.9)11 (25.0).216PVI9 (25.0)23 (52.3).013Major amputation5 (13.9)3 (6.8).294Wound characteristics/outcomes Ankle brachial index (<30 days from appearance)18 (51.4)40 (90.9)<.001 Wound area, cm2Evaluation10.0 ± 2.6 [4.7, 15.4]14.3 ± 2.5 [9.2, 19.3].245Largest size11.8 ± 2.5 [6.7, 16.9]27.1 ± 4.7 [17.6, 36.6].002 WIfI wound score1.6 ± 0.1 [1.3, 1.8]1.9 ± 0.1 [1.6, 2.1].039 Gangrene (yes)7 (19.4)18 (40.0).05 OsteomyelitisXR/MRI20 (55.6)14 (31.8).033Debridement/amputation12 (63.2)15 (100).008 Developed additional wounds (same limb)8 (22.9)3 (6.7).037 Mean time appearance to largest, days176 ± 32.0 [111, 241]70.1 ± 13.4 [43.1, 97.1]<.001 Mean time to 15% size reduction, days197 ± 45.2 [105, 290]99.1 ± 12.0 [74.7, 123].044 Mean time to 75% granulation, days190 ± 48.4 [90.9, 290]118 ± 14.0 [89.3, 146].05 Mean time to epithelialization, days268 ± 50.4 [164, 372]143 ± 18.4 [105, 181].026 Visits/proceduresWound center15.4 ± 3.4 [8.6, 22.2]7.7 ± 1.4 [4.9, 10.4].024Clinic procedures9.9 ± 1.5 [7.0, 12.9]5.4 ± 0.8 [3.9, 7.0].005Surgical provider5.5 ± 1.5 [2.4, 8.6]3.4 ± 0.47 [2.5, 4.4].210Operative procedures1.2 ± 0.2 [0.7, 1.7]2.3 ± 0.3 [1.7, 3.0].008 Surgical providerPodiatry23 (63.9)36 (81.8).070Other specialty15 (41.7)12 (27.3).176Vascular surgery29 (80.6)45 (100).036 Procedure after first surgical provider visit (yes)10 (28.6)24 (53.3).026 Mean time from appearance, daysTo revascularization146 ± 21.4 [99.1, 192]48.0 ± 13.7 [19.6, 76.4]<.001To minor amputation/debridement178 ± 51.6 [67.9, 288]41.9 ± 9.79 [21.7, 62.0].002 Major amputation4 (11.4)7 (15.6).595Documented nonsalvageable prior2 (50.0)7 (100).658BMI, Body mass index; CI, confidence interval; CKD, chronic kidney disease; ESRD, end-stage renal disease; LE, lower extremity; MRI, magnetic resonance imaging; PVI, peripheral vascular intervention; WIfI, wound, infection, and ischemia scoring system; XR, X-ray.Cardiac intervention = includes percutaneous or bypass procedures; enrollment = medications recorded at intake on the patient's first wound care visit; discharge = medications recorded at the patient's last wound care visit. 75% granulation = composition of wound documented with the presence of 75% granulation tissue present; 15% reduction = reduction in size >15% from the largest size recorded for specific wound; epithelialization = presence of any epithelialization over wound; discharge = last recorded wound care visit.Data are presented as mean ± standard error [95% CI] or number (% of total n).Boldface P values represent statistical significance, P < .05. Open table in a new tab Table IICox regression modeling of individual factors affecting time to wound healingHealed (included)Yes (variable)Hazard ratioP valueEarly (<6 weeks) vascular provider encounter54321.74 [0.97, 3.09].062History of heart failure54190.53 [0.29, 0.97]a.038History of chronic pain54151.79 [0.96, 3.33].068Use of anticoagulation (enrollment)54142.53 [1.30, 4.95]a.006Full ambulatory status (initial)54210.41 [0.18, 0.93]a.033Presence of gangrene (initial)54330.50 [0.28, 0.89]a.019Osteomyelitis on XR/MRI54250.48 [0.26, 0.90]a.022Combined Cox regression modelEarly (<6 weeks) vascular provider encounter54321.984 [1.06, 3.71]a.032History of heart failure54190.56 [0.30, 1.068].078History of chronic pain54151.40 [0.72, 2.73].324Use of anticoagulation (enrollment)54142.78 [1.39, 5.59]a.004Full ambulatory status (initial)54210.51 [0.21, 1.23].136Presence of gangrene (initial)54330.67 [0.32, 1.40].291Osteomyelitis on XR/MRI54250.58 [0.27, 1.26].170XR, X-ray; MRI, magnetic resonance imaging.Boldface P values represent statistical significance, P < .1.Major amputation = above ankle.aClinical significance indicated by confidence interval that does not contain 1. 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