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
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.
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
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
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.
Woman 70 years old: Open sore of the
leg since two months. Operation of the long saphenous vein on July 21,
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.
||Woman 86 years old with an ulcer as
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.
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.
healing after stripping of the small saphenous vein and local wound
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.