True about venous ulcer
Venous Ulcers Causes of Leg ulcers Venous disease : Superficial incompetence ; deep venous damage (post - thrombotic) Aerial ISchemic ulcers Rheumatoid ulcers Traumatic ulcers Neuropathic ulcers (Diabetes) Neoplastic ulcers (SCC and BCC) Clinical features Venous ulcers: Sloping edge, base contains granulation tissue covered by Slough and exudate Any elevation of the ulcer edge should indicate the need for a biopsy to exclude a carcinoma (SCC or BCC) Venous ulcer of the leg characteristically develops in the skin of the gaiter region, the area between muscles of the calf & ankle Majority of ulcers develop on the medial side of the calf Ulcers associated with lesser saphenous incompetence often develop on the lateral side of the leg Almost all venous ulcers have surrounding lipdermatosclerosis (thickening, pigmentation, inflammation & induration of calf skin) Pigmentation comes from hemosiderin & melanin Presence of ankle flare suggests venous hypeension Diagnosis Duplex Ultra sound : Assess the state of deep & superficial veins (IOC) Bipedal ascending phlebography :Detect obstruction & post-thrombotic changes missed by the duplex scan Management Probable venous ulcer : Patients are initially treated by a compression bandaging regimen. A multilayered elastic compression bandaging system has been shown to be effective (Chariging Cross four-layer bandage), as has a rigid multilayered system (Steripaste three layer bandage) Ref: Sabiston 20th edition Pgno :1832
Always stripping done
Always examine deep venous system
Biopsy should be taken from chronic ulcer
A/w Klippel-Trenaunary syndrome
Vascular surgery