A 47-year-old man with chronic post-thrombotic edema of the left leg has an irregular non-healing ulcer above the medial malleolus. The following is/are true:
A. The cause of the ulceration is extension of venous thrombosis to the superficial capillary bedB. The ulcer is certain to be infected and merits antibiotic treatment
C. The underlying perforating veins are likely incompetent
D. Isolated saphenous vein incompetence can produce such a situation
E. Immidiate excision of ulcerated area is best management
The answer is. C.
The underlying perforating veins are likely incompetent, D. Isolated
saphenous vein incompetence can produce such a situation
The
presentation indicates chronic venous insufficiency with stasis ulceration
secondary to sustained venous hypertension. The pathophysiology involves
leukocyte capillary trapping, an inflammatory reaction, and scarring of the
subcutaneous tissues with ischemia of the skin. The stasis ulcer can be managed
by occlusive dressing, special boots and elastic support without antibiotics.
The location is typical for stasis ulcer due to adjacent underlying incompetent
perforator veins. Such a situation can also be seen with isolated saphenous vein
incompetence.
