​What is Surgery – Venous Ulcer Treatment

​What is Surgery – Venous Ulcer Treatment 

DEFINITION of venous leg ulcers
Leg ulcers are caused by venous insufficiency and account for 80–85 percent of all leg ulcers. 
AETIOLOGY 
Increased hydrostatic pressure, tissue oedema, decreased microcirculation, and eventually tissue necrosis and ulceration ensue from venous hypertension produced by superficial or profound venous incompetence. The 'fibrin cuff' in the tissue, white cell entrapment, and/or persistent inflammation after ischaemia reperfusion damage have all been proposed as mechanisms. 

EPIDEMIOLOGY
In affluent countries, about 1% of the population may develop a leg ulcer, a substantial burden on healthcare services that increases with age, female>male. 

HISTORY
 Heaviness, leg pain, ankle swelling, skin changes, itching, and ulceration are all symptoms of chronic venous insufficiency. Determine whether there are any risk factors for DVT or peripheral vascular disease. 

EXAMINATION 
A venous ulcer is most commonly found in the 'gaiter area' above the medial malleolus. Lipodermatosclerosis, varicose eczema, pigmentation, and atrophie blanche are common causes of superficial ulceration with sloping borders. While the patient is standing, check for varicose veins. To check for concomitant peripheral arterial disease, calculate the ankle–brachial pressure index (ABPI). 

Atherosclerotic, diabetic, neuropathic, vasculitic, infective, and neoplastic ulcers are among the differential diagnoses. 

INVESTIGATIONS 
ABPI (ankle–brachial pressure index): ABPIs should be used to screen all patients for vascular disease. Modified compression may be possible for people with an ABPI of 0.5–0.8, and those with an ABPI of 0.5 should be referred/assessed for arterial insufficiency therapy in the first instance. 

If there are symptoms of infection, such as discharge, erythema, cellulitis, or pyrexia, a microbiology swab should be taken. If there is any suspicion of cancer, a biopsy or cytology should be performed. 

MANAGEMENT 
Compression bandaging with multiple components: Multi-layer compression, such as the Charing Cross four-layer bandage of wool, crepe, elastic, and cohesive bandages, is used to treat venous hypertension. Leg elevation and mobility tips. Compression stockings prevent recurrence once the wound has healed. Antibiotics should only be used in the case of infected ulcers with cellulitis. Pentoxifylline could be a useful supplement.

 Topical treatments, routine systemic antibiotics, and dressing style have all been demonstrated to have little effect on healing.

Varicose veins can be treated with endovascular or open surgery. The ESCHAR (Effect of Surgery and Compression on Healing and Recurrence) study found that superficial venous surgery did not hasten healing but does assist prevent recurrence once it is healed. In some cases, skin grafting may be necessary.

COMPLICATIONS
Chronic wounds, infection, recurrence, and cancer development in long-term ulcers (Marjolin's ulcer). 

PROGNOSIS 
It's usually a long-term issue with varying recovery times. Recurrence rates are roughly 25% after one year and 33% after 18 months after healing.