Which of the following is NOT a sign of advanced ischemia in the lower extremity?

In the context of advanced ischemia in the lower extremity, true pitting edema is not typically associated as a sign. Pitting edema generally indicates fluid accumulation due to venous insufficiency or other vascular problems, rather than insufficient blood flow, which characterizes ischemia.

Advanced ischemia usually presents with symptoms like pallor on elevation, where the skin becomes pale due to reduced blood flow when the leg is raised. When the leg is then lowered and blood flow resumes, rubor on dependency may occur, characterized by a reddish discoloration as blood pools in the extremity. Ulceration at the dorsum of the foot is also a severe manifestation of ischemia, indicating tissue death due to a prolonged lack of blood supply.

Thus, true pitting edema stands apart from these signs, as it reflects different underlying pathology related to fluid retention rather than diminished blood supply, making it the answer that does not align with the signs of advanced ischemia.