The effective management of venous ulceration

Abstract

The importance of the direct perforating veins of the lower leg in the aetiology of venous ulceration is supported by the results of a 6-year study of 77 patients with 109 ulcerated legs. Incompetent perforating veins were demonstrated by examination and Doppler ultrasound, and confirmed at operation, in 108 legs. Subfascial ligation of these veins, with stripping of incompetent saphenous veins when necessary, was followed by elastic compression stockings in 44 legs (40 per cent) in which deep vein incompetence was demonstrated by non-invasive methods and phlebography. Some 91 ulcers (84.3 per cent) remain healed (76 per cent greater than 3-year follow up). Eight patients with rheumatoid arthritis in addition to venous incompetence had a 75 per cent failure rate. If these patients are excluded, 88 (92 per cent) of 96 ulcerated legs remain healed. It is submitted that these results support the argument for the importance of perforating vein incompetence in the aetiology of venous ulceration. They also suggest that a more optimistic attitude towards treatment is justified.

Poor Prognosis of Arthritis-Associated Pyoderma Gangrenosum

“…Interestingly, cutaneous ulcerations secondary to arthritis are known to be particularly resistant to treatment and associated with a great deal of morbidity. 15 While this report demonstrates the refractory nature of PGA ulcers, there are inherent limitations to this case study. First, only 18 patients met the inclusion criteria and were studied.…”

A Prospective Study in Comparison of Ambulatory Phlebectomy and Duplex Guided Foam Sclerotherapy in the Management of Varicosities with Isolated Perforator Incompetence

“…(a) Negus and Friedgood et al [12], having an ulcer healing rate of 84 % and a recurrence rate of 15 % (b) Pierik et al [13], having a healing percentage of 90 % and a recurrence rate of 0 % (c) Sato et al [14], having an ulcer healing rate of 100 % and a recurrence rate of 68 % Contradicting to the results of this study, Burnard et al [15] found satisfactory healing of ulcers but the ulcer recurrence rate was 55 % in the study of perforator interruption. The reason for the high recurrence rates in the studies by Burnard et al was due to the fact that only class 5 ulcers were admitted in the study.…”

Cirurgia Endoscópica Subfascial de veias Perfurantes Insuficientes (CESPI): experiência inicial

“…Estudos publicados após 1980, de autores que utilizaram a técnica de Linton com modificações ou não, nos quais a média de tempo de seguimento dos doentes foi de três anos ou mais, relataram taxas de recidivas variáveis de 13% a 51%. [17][18][19][20] . É difícil explicar esta variação.…”