Venous ulcer:A pedal misery!

Venous ulcer:A pedal misery!

• 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
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  Clinical features ofvenous ulcerClinical features of venous ulcer InspectionInspection – SiteSite – SolitarySolitary – Surrounding skinSurrounding skin – Associated varicoseAssociated varicose veinsveins
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  Clinical features ofvenous 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
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  InvestigationsInvestigations Doppler ultrasoundDoppler ultrasound Xray local partsX ray local parts Swab-scastSwab-scast
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  Treatment of venousulcerTreatment 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
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  Treatment of venousulcerTreatment 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