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VARICOSE ULCERS -
Venous Leg Ulcers
Leg Ulcers are present in 1 – 2 % of the adult population. In the majority of cases, leg ulcers are due to chronic venous disease, either Varicose Veins or Deep Vein Thrombosis.
Venous leg ulcers are due to increased pressure in the venous circulation, either because of Superficial Vein reflux (Varicose Veins) or Deep Venous reflux (as a result of DVT).
Proper compression therapy, with sustained pressure is essential in the treatment of leg ulcers. This compression bandaging may be required for several weeks for proper healing of ulcers. If the patient with venous ulcer has significant superficial reflux, either isolated or in association with perforator vein reflux, then good improvement is obtained by treating these conditions – which helps in the healing rate of the ulcers.
Treatment with Endovenous Laser and Foam Sclerotherapy promotes a much more rapid healing.
Case Studies
Case Study 1
 This
45 year old cook was suffering from a non healing
venous ulcer since the last 3 years. He was found to
have an incompetent sapheno femoral valve leading to
gross insufficiency, and dilatation of the great
saphenous vein. He also had multiple above ankle
perforator vein valve incompetence. He underwent
endovenous laser treatment to close the great
saphenous vein, and foam Sclerotherapy using 3%
sodium tetradecyl sulphate to close the incompetent
perforators. Plermin ointment was then applied to
the venous wound, along with compression bandage.
There was complete resolution of the venous ulcer
within a period of 2 months. At followup of 18
months, there has been no recurrence of the ulcer. |
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Case Study 2
 42
year old shopkeeper, with a job requiring standing
upto 15 hours per day, developed significant
superficial varicosities in the right leg, finally
leading to a non healing ulcer above the right
medial malleolus. Compression bandage therapy proved
to be of no benefit. He finally underwent endovenous
laser treatment to close the dilated and incompetent
great saphenous vein and the associated incompetent
perforators. Following this compression stockings
(Class II) were prescribed, along with Plermin
ointment locally to assist wound healing. Within one
month, there was complete resolution and healing of
the ulcer along with eradication of his superficial
varicosities. Ultrasound examination confirmed
closure of all the previously incompetent perforator
veins. |
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Case Study 3
 60
year old shopkeeper who had developed gradual
pigmentation of the right leg with eventual
formation of an ulcer, which did not heal for over
one year, inspite of all possible treatments.
Finally, he was evaluated and found to have
incompetent perforator vein valves, which was
treated with a combination of endovenous laser and
foam Sclerotherapy. Subsequently, the wound was
cleaned daily with normal saline and coated with
Plermin ointment. The picture given below shows the
remarkable improvement in wound healing within one
month.. |
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Case Study 4
This 70 year old gentleman with gross incompetence
of the right saphenofemoral valve and varicosity of
the great saphenous vein, and associated perforator
incompetence had developed a large ulcer in the
right leg. This was present since the last 7 months,
gradually increasing in size. Following closure of
the incompetent valve and obliteration of the GSV
and the incompetent perforator veins by endovenous
laser, he was treated with daily dressings using
Plermin. The results shown below in 2 months show
the efficacy of treatment. |
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Case Study 5
 This
84 years old lady non-diabetic, hypertensive, had a
large non-healing ulcer on the dorsum of the foot,
since last three years. Ultrasound doppler
evaluation revealed no arterial insufficiency;
however, there were multiple incompetent perforators
in the mid and distal leg. She underwent treatment
with a combination of Endovenous Laser and Foam
Sclerotherapy. The ulcer was than treated by topical
application of plermin ointment daily. As seen below
there was complete healing of the ulcer within a
period of six weeks.. |
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