Vein Disease
※ The treatment results may vary from person to person. Please consult the doctor before treatment.
Venous Ulcer //
ARTERIAL ULCER
There are three kinds of vascular leg ulcers: arterial, venous, mixed.
Cause: tissue ischemia due to arterial stenosis or occlusion. Most of the situations are associated with atherosclerosis.
They are most commonly seen on toes (Figure 1) or ankles (Figure 2).
Figure 1
Ankle arterial ulcer
Figure 2
Toe arterial ulcer
VENOUS ULCER
Superficial venous hypertension due to reflux or obstruction of the leg veins is attributed to the major cause of the venous ulcer. Most of the venous ulcers occur on the medial or lateral aspects of the ankle area, followed by anterior or medial aspects of middle calf. The common findings are thickening and hyperpigmentation over the affected area (Figure 3) that progress to a unhealed ulcer (Figure 4).
Figure 3
Skin thickening and darkening with a healed ulcer
Figure 4
Calf venous ulcer with infection
TREATMENT OF VENOUS ULCER
The first step is to find out the source of venous hypertension. Common causes are reflux of great or small saphenous veins, incompetent perforating vein or venous insufficiency post deep vein thrombosis.
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Endovenous laser ablation (EVLA) (Figure 5) or Radiofrequency ablation (RFA) are the most useful method to abolish reflux of great or small saphenous veins.
Figure 5A
Endovenous laser ablation
Figure 5B
The console screen showing the parameters used in EVLA
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Use injection microsclerotherapy or ultrasound-guided sclerotherapy to close the branch varicosities.
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Use specialized dressings, such as Aquacel foam or Aquacel Ag Surgical, to absorb exudate, prevent secondary bacterial infection, moisturize the wound, and hence speed up wound healing (Figure 6).
Figure 6A
The ankle venous ulcer
Figure 6B
Aquacel foam for covering the ulcer
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Use class II and above compression stockings to abolish reflux from incompetent perforating vein and improve venous return and reduce edema (Figure 7).
Figure 7
Class II compression stocking on right leg
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Wound infection or necrosis need surgical debridement and antibiotic treatment. A large and deep wound may need skin graft.
CASE PRESENTATION
Case 1
Case 2
Case 3
