Varicose Ulcer

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 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.

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.

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..

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.

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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