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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

Complicated venous ulcer for which sural artery flap was done and it healed
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Figure 6: Complicated venous ulcer for which sural artery flap was done and it healed

Mentions: Surgical treatment was required for nineteen patients(65.5%) as their ulcers were deep and recalcitrant. Split thickness skin grafting of varying thickness[13] was done for eleven superficial ulcers out of which ten were successful and there was one failure [Figure 4]. Full thickness skin grafting[14] was done for four cases with deep ulcers. There were three failures and one successful healing [Figure 5]. Pedicled flap cover[15] was done for two deep ulcers exposing muscle as they were able to provide good vascularised tissue to reduce the ongoing ulceration One patient was treated with reverse sural artery flap and the other with local fasciocutaneous flap after good debridement. Both the ulcers healed satisfactorily. No recurrence has been encountered in a follow up of 2 years [Figure 6]. Free flaps[161718] were used in two patients with deep ulcers having skin changes with lipodermatosclerosis (LDS). Latissimus dorsi free muscle flap in the one and a free anterolateral thigh flap [Figure 7] in the other patient were done. Both flaps settled well (6.89% of total cases) and the patients are ulcer free on follow up. In our study, we did not use V.A.C therapy[19] due to prohibitive cost of the commercial unit. In summary, surgically good results were obtained in fifteen out of twenty nine cases (51.72%).Four cases failed to heal. The outcome of the procedures is summarised in the Table 5.


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

Alamelu V - Indian J Plast Surg (2011)

Complicated venous ulcer for which sural artery flap was done and it healed
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Complicated venous ulcer for which sural artery flap was done and it healed
Mentions: Surgical treatment was required for nineteen patients(65.5%) as their ulcers were deep and recalcitrant. Split thickness skin grafting of varying thickness[13] was done for eleven superficial ulcers out of which ten were successful and there was one failure [Figure 4]. Full thickness skin grafting[14] was done for four cases with deep ulcers. There were three failures and one successful healing [Figure 5]. Pedicled flap cover[15] was done for two deep ulcers exposing muscle as they were able to provide good vascularised tissue to reduce the ongoing ulceration One patient was treated with reverse sural artery flap and the other with local fasciocutaneous flap after good debridement. Both the ulcers healed satisfactorily. No recurrence has been encountered in a follow up of 2 years [Figure 6]. Free flaps[161718] were used in two patients with deep ulcers having skin changes with lipodermatosclerosis (LDS). Latissimus dorsi free muscle flap in the one and a free anterolateral thigh flap [Figure 7] in the other patient were done. Both flaps settled well (6.89% of total cases) and the patients are ulcer free on follow up. In our study, we did not use V.A.C therapy[19] due to prohibitive cost of the commercial unit. In summary, surgically good results were obtained in fifteen out of twenty nine cases (51.72%).Four cases failed to heal. The outcome of the procedures is summarised in the Table 5.

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