Venous ulcer is one of the commonest complication of varicose veins. It may also occur in a condition called post phlebitic limb which is a sequelae to acute deep vein thronbosis. Hurry in surgical treatment of this condition before the ulcer heals could lead to a failure. Good conservative treatment for healing of the ulcer followed by surgical intervention gives the best results.

1. Venous UlcerVenous Ulcer
ByBy
Dr. Ketan VagholkarDr. Ketan Vagholkar
MS, DNB, MRCS, FACS.MS, DNB, MRCS, FACS.
Professor of SurgeryProfessor of Surgery
&&
Consultant General Surgeon.Consultant General Surgeon.

2. Venous ulcerVenous ulcer
EtiologyEtiology
– Varicose veinsVaricose veins
– Postphlebitic limbPostphlebitic limb
PathologyPathology
– Venous hypertensionVenous hypertension
– ExtravasationExtravasation
– HyperpigmentationHyperpigmentation
– EczemaEczema
– UlcerationUlceration
– Bleeding from theBleeding from the
underlyingunderlying
incompetant perforatorincompetant perforator

3. Clinical features of venous ulcerClinical features of venous ulcer
InspectionInspection
– SiteSite
– SolitarySolitary
– Surrounding skinSurrounding skin
– Associated varicoseAssociated varicose
veinsveins

4. Clinical features of venous ulcerClinical features of venous ulcer
PalpationPalpation
– TendernessTenderness
– Fixity to underlying structuresFixity to underlying structures
– Tests for perforator or deep vein insufficiencyTests for perforator or deep vein insufficiency
– Lymph nodesLymph nodes
– Bony deformities due to abnormal gaitBony deformities due to abnormal gait

5. InvestigationsInvestigations
Doppler ultrasoundDoppler ultrasound
X ray local partsX ray local parts
Swab-scastSwab-scast

6. Treatment of venous ulcerTreatment of venous ulcer
Bisgaard RegimeBisgaard Regime
– Massage in elevation toMassage in elevation to
soften the indurated areasoften the indurated area
– Passive mvts to maintainPassive mvts to maintain
mobility of the ankle andmobility of the ankle and
footfoot
– Active mvts to strenghthenActive mvts to strenghthen
the calf musclesthe calf muscles
– Gait trainingGait training
– Elastocrepe bandageElastocrepe bandage
supportsupport
Dry dressings toDry dressings to
stimulate woundstimulate wound
healinghealing
Surgery only afterSurgery only after
wound healing iswound healing is
completecomplete
Subfascial ligation ofSubfascial ligation of
the underlyingthe underlying
incompetantincompetant
perforatorperforator

7. Treatment of venous ulcerTreatment of venous ulcer
Bisgaard RegimeBisgaard Regime
– Massage in elevation toMassage in elevation to
soften the indurated areasoften the indurated area
– Passive mvts to maintainPassive mvts to maintain
mobility of the ankle andmobility of the ankle and
footfoot
– Active mvts to strenghthenActive mvts to strenghthen
the calf musclesthe calf muscles
– Gait trainingGait training
– Elastocrepe bandageElastocrepe bandage
supportsupport
Dry dressings toDry dressings to
stimulate woundstimulate wound
healinghealing
Surgery only afterSurgery only after
wound healing iswound healing is
completecomplete
Subfascial ligation ofSubfascial ligation of
the underlyingthe underlying
incompetantincompetant
perforatorperforator