Classification Vascular → arterial → Lymphatic

→ Venous Infection → Chronic Osteomyelitis

TB,Syphilis

Systemic DM, Sickle cell anemia Neoplastic Sq. cell carcinoma ,

Melanoma Metastatic Traumatic Radiation

Classification

Pathogenesis

Venues 40% arterial 20% others 40%

Venous Ulcer

Pathogenesis :-

Venous hypertension ------ 1 ry reflux 70% ( genetic)

------ 2 ry reflux 30%

(DVT) W.B.C activation V. Hypertension Or

Fibrin Cuff

Dermatolibosclerosis ulcerationulcer

Diagnosis

History up to 35% of the adult

population have some of the following V. Disease , DM, T.B, tumour ……… etc.

General exam ------ Anaemia (healing)

------- Jundice (tumour )

Local exam Site , Size , Shape and Edge.

Investigations

General: C.B.P, W.B.C, E.S.R, C.R.P.…

Specific: according to the primary diagnosis

Vascular Duplex Infective C & S

Neoplastic Biopsy

Investigation

Duplex Study Arteriography Plethysmogaphy Ascending Phlebography Descending CT Scan Isotope – scanning MRA

Treatment

General Treatment

Conservative

Topical Therapy

Surgical Reconstructive

Debridement

Skin graft

Treatment

Conservative Bed rest + limb elevation

( effective therapy but impractical ) Drugs-------- Zinc

------- Pentoxiphylline

------- I.v. prostaglandin

Treatment

•Gradient compression =Dynamic ( unna boot )

=Static: -

Stocting , - Multilayered elastic

wrapped dressing

Treatment

Sclerotherapy: Foam injection

Treatment

Surgical V Vs surgery:

• High tie

• Stripping

• Perforators ligation

• Multiple avulsions

Treatment

Arterial bypass. Debridment. Skin Graft.