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Is chronic venous ulcer curable? A sample survey of a plastic surgeon.

Alamelu V - Indian J Plast Surg (2011)

Bottom Line: Remaining nineteen cases were given surgical modality in which fifteen cases (51.74%) were successful.Only seven cases (24.13%) failed to heal.Foot care, regular exercises and follow-up were stressed effectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College and Govt General Hospital, Chennai - 600 003; Sri Jayam Hospital, West Tambaram, Chennai - 600 045; K.J. Hospital and Research Foundation, Poonamallee High Road, Chennai - 600 084, India.

ABSTRACT

Introduction: Venous ulcers of lower limbs are often chronic and non-healing, many a time neglected by patients and their treating physicians as these ulcers mostly do not lead to amputation as in gangrenous arterial ulcer and also cost much to complete the course of treatment and prevention of recurrence.

Materials and methods: One hundred and twenty two lower limb venous ulcers came up for treatment between May 2006 and April 2009. Only twenty nine cases completed the treatment. The main tool of investigation was the non invasive Duplex scan venography. Biopsy of the ulcer was done for staging the disease. Patients' choice of treatment was always conservative and as out-patient instead of hospitalisation and surgery, which required a lot of motivation by the treating unit.

Results: Out of twenty nine cases, ten cases were treated conservatively and seven (24.13%) healed well. Remaining nineteen cases were given surgical modality in which fifteen cases (51.74%) were successful. Only seven cases (24.13%) failed to heal. Compression stockings were advised to control oedema, varices and pain. Foot care, regular exercises and follow-up were stressed effectively.

No MeSH data available.


Related in: MedlinePlus

Chronic superficial venous ulcer lateral malleolus and duplex scan picture with reflux, (a) Chronic venous ulcer-lateral malleolus, (b) Incompetent perforators with damage to valves. Blood flows towards probe. subcutaneous edema seen
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Figure 1: Chronic superficial venous ulcer lateral malleolus and duplex scan picture with reflux, (a) Chronic venous ulcer-lateral malleolus, (b) Incompetent perforators with damage to valves. Blood flows towards probe. subcutaneous edema seen

Mentions: Investigations for basic vital parameters and specific ones in only severe thrombotic ulcers, like prothrombin time, platelet count, international ratio (PT, PC, INR values) were done. X-ray of the leg and foot, wound culture and sensitivity and abdominal ultrasonogram were also done routinely. Doppler study showed normal Ankle Brachial Index (ABI) between o.8 and 1.1, ruling out arterial insufficiency in these ulcers.[45] Duplex scan venography was done in all cases as it is the gold standard to evaluate both anatomical and functional changes of the venous system [Figure 1].[67] Valveless major and perforator veins were seen with reflux. An analysis of scan findings revealed mostly post thrombotic features as depicted in Table 4. Biopsy of the ulcer was done from the edge and scrapings. Histopathological findings showed typical large venous sinuses with pericapillary inflammation, showing macrophages with plenty of neutrophils near the vessel wall, with non healing granuloma. Destruction of normal subcutaneous tissue and replacement with thick fibrosis was also detected with severe skin destruction and ulcer crater [Figure 2].[8]


Is chronic venous ulcer curable? A sample survey of a plastic surgeon.

Alamelu V - Indian J Plast Surg (2011)

Chronic superficial venous ulcer lateral malleolus and duplex scan picture with reflux, (a) Chronic venous ulcer-lateral malleolus, (b) Incompetent perforators with damage to valves. Blood flows towards probe. subcutaneous edema seen
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111099&req=5

Figure 1: Chronic superficial venous ulcer lateral malleolus and duplex scan picture with reflux, (a) Chronic venous ulcer-lateral malleolus, (b) Incompetent perforators with damage to valves. Blood flows towards probe. subcutaneous edema seen
Mentions: Investigations for basic vital parameters and specific ones in only severe thrombotic ulcers, like prothrombin time, platelet count, international ratio (PT, PC, INR values) were done. X-ray of the leg and foot, wound culture and sensitivity and abdominal ultrasonogram were also done routinely. Doppler study showed normal Ankle Brachial Index (ABI) between o.8 and 1.1, ruling out arterial insufficiency in these ulcers.[45] Duplex scan venography was done in all cases as it is the gold standard to evaluate both anatomical and functional changes of the venous system [Figure 1].[67] Valveless major and perforator veins were seen with reflux. An analysis of scan findings revealed mostly post thrombotic features as depicted in Table 4. Biopsy of the ulcer was done from the edge and scrapings. Histopathological findings showed typical large venous sinuses with pericapillary inflammation, showing macrophages with plenty of neutrophils near the vessel wall, with non healing granuloma. Destruction of normal subcutaneous tissue and replacement with thick fibrosis was also detected with severe skin destruction and ulcer crater [Figure 2].[8]

Bottom Line: Remaining nineteen cases were given surgical modality in which fifteen cases (51.74%) were successful.Only seven cases (24.13%) failed to heal.Foot care, regular exercises and follow-up were stressed effectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic, Reconstructive and Faciomaxillary Surgery, Madras Medical College and Govt General Hospital, Chennai - 600 003; Sri Jayam Hospital, West Tambaram, Chennai - 600 045; K.J. Hospital and Research Foundation, Poonamallee High Road, Chennai - 600 084, India.

ABSTRACT

Introduction: Venous ulcers of lower limbs are often chronic and non-healing, many a time neglected by patients and their treating physicians as these ulcers mostly do not lead to amputation as in gangrenous arterial ulcer and also cost much to complete the course of treatment and prevention of recurrence.

Materials and methods: One hundred and twenty two lower limb venous ulcers came up for treatment between May 2006 and April 2009. Only twenty nine cases completed the treatment. The main tool of investigation was the non invasive Duplex scan venography. Biopsy of the ulcer was done for staging the disease. Patients' choice of treatment was always conservative and as out-patient instead of hospitalisation and surgery, which required a lot of motivation by the treating unit.

Results: Out of twenty nine cases, ten cases were treated conservatively and seven (24.13%) healed well. Remaining nineteen cases were given surgical modality in which fifteen cases (51.74%) were successful. Only seven cases (24.13%) failed to heal. Compression stockings were advised to control oedema, varices and pain. Foot care, regular exercises and follow-up were stressed effectively.

No MeSH data available.


Related in: MedlinePlus