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Varicose veins

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Venous leg ulcers

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Venous leg ulcers

These are the classical open leg ulcers. Like the underlying varicosity that usually causes this condition, it has no parallel in the animal world. It is an ancient disease linked with walking upright, which has been torturing Man since pre-historic times. It is also known to medicine since ages.

Plausible surmises concerning the origin of venous leg ulcers (reflux of venous blood from the upper to the lower portions of the leg) are being made for about a hundred years now.

In view of these facts, one is surprised to find a large number of open leg ulcers still being treated with ointments instead of eliminating the varicose veins responsible for this condition.

True: in a few cases venous leg ulcers are caused by a leg vein thrombosis that occurred several years ago. However, many venous ulcers are only presumed to arise from postthrombotic disorders. This scenario of insufficient treatment is accompanied by the still widespread belief that one should not undergo surgery for varicose veins if one has a wound in the leg.

 
Click: Venous leg ulcers

The elimination of varicose veins and the cause of usually non-healing leg ulcers of long duration is the order of the day because blood flows down constantly and contrary to plan, like a waterfall, along the leg and is “wasted” particularly in the region of the ankle. If one tries to cure such a varicose ulcer without eliminating the cause – surprisingly, such attempts are crowned with success in some cases – it is like trying to dry oneself under a shower without turning off the water.

Here are examples for the stages of healing:

Click: Example 1-1 from 15.3.2005
Click: Example 1-2 from 30.3.2005
Click: Example 1-3 from 30.4.2005
Click: Example 1-4 from 10.8.2005
Click: Example 1-5 from 22.9.2005




Woman 79 years of age: has been suffering from an open sore of her left leg caused by a varicose long saphenous vein insufficient in the groin. Operation was done on April 12, 2005.

     
Click: Example 2-1 from 31.3.2005
Click: Example 2-2 from 18.5.2005
Click: Example 2-3 from 17.8.2005

Woman 71 years of age: Venous leg ulcer since one year, caused also by a varicose long saphienous vein. Operation was done on April 7, 2005.

     
Click: Example 3-1 from 18.7.2005
Click: Example 3-2 from 8.8.2005
Click: Example 3-3 from 29.8.2005

Woman 70 years old: Open sore of the leg since two months. Operation of the long saphenous vein on July 21, 2005.

Click: Example l-1 from 4.4.2005

Click: Example l-2 from 18.7.2005

Click: Example 4-3 from 23.4.2007
  Woman 86 years old with an ulcer as well on the inner as on the outer ankle; intermittendly open for more than 20 years. The cause is also a varicose long saphenous vein, but also insufficient short saphenous vein. Healing is starting right after the operation and takes two years.  
Click: Example 5-1 from 4.4.2005

Click: Example 5-2 from 18.7.2005

Click: Example 5-3 from 23.4.2007
 
Click: Example Ulkus 1
Click: Example Ulkus 2
Click: Example Ulkus 3
Click: Example Ulkus 4
An ulcer that comprises the whole circumference of the leg - without leaving even a small skin bridge - will never heal by conservative measures alone; it has to be grafted.
    
Click: dangerous leg ulcers
Click: dangerous leg ulcers
Click: dangerous leg ulcers

A post-thrombotic condition?

One might be tempted to believe it is a post-thrombotic condition but it is not. I last inspected this rather corpulent 55-year-old man 21 years ago: he had a tiny ulcer and a discrete swelling in the ankle. A Doppler ultrasound investigation could not be performed at the time. Today it is evident that the now dramatic situation – the patient is about to experience an “open leg ulcer” due to varicosity – was caused by a varicose vein in the inner aspect of the knee over a period of about 30 years. Without performing an exact investigation one would diagnose this condition incorrectly and refrain from performing the operation.

Too little attention is given to the blood from the small saphenous vein flowing out of the knee cavity as a cause of leg ulcers, occasionally in the inner ankle and particularly in the outer ankle. In rare cases it causes ulcers on the back of the foot, as can be seen here in the case of an 82-year-old woman.

          
Click: dangerous leg ulcers
Click: dangerous leg ulcers

Gradual healing after stripping of the small saphenous vein and local wound treatment

          
Click: dangerous leg ulcers
Click: dangerous leg ulcers

This is the remarkable healing of a leg ulcer, one year old, in a gentleman of 68 years. Remarkable is not only the size of the ulcer but also its being situated over the shin which potentially exposes it to unfavourable pressure peaks by the bandage. As to the possible cause of the ulceration the only lesion found was an incompetent Boyd's perforant vein which was closed by ligature.

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