The soft tissue injury sebelum ulceration begins in the subcutis
Appearance of petechial lesions
As the hemoglobin in the petechial lesionsbreaks down, the iron remains in the skin as hemosiderin and may lead toimpressive discoloration.
Stasis dermatitis, characterized by erythema, scaling, pruritus, erosions,oozing, crusting, and occasional vesicles.
Varicose veins, especially noticeable when the patient is standing
Althoughthey are usually asymptomatic, patients may complain of symptoms of aching,cramping, itching, fatigue, and swelling that are worse with prolonged standing.
The skin at the ankle is usually thin, shiny, atrophic, and a brownishpigmentation often develops.
congestive heart failure, chronic renal disease, ordecompensated liver disease
may have bilateral edema of the lower extremities. Tapi edema karena penyakit itu, causes pits easily and brawny discoloration is rare.
is associated with edema, usually unilateral, in thesubcutaneous tissue that does not respond readily to elevation;
, and there is often a history of recurrent cellulitis.
Other conditions associated with chronic ulcers of the leg include
autoimmunediseases (eg. Felty's syndrome), arterial insufficiency (often very painfulwith absent pulses), sickle cell anemia, erythema induratum (bilateral andusually on the posterior aspect of the lower part of the leg), and fungalinfections (cultures specific: no chronic swelling or varicosities).
HISTOPATHOLOGY of VARICOSE VEIN
Macroscopic : Veins with varicosities are
dilated, tortuous, elongated, andscarred,
thinning at the points of maximal dilation
Intraluminalthrombosis and valvular deformities
(thickening, rolling, and shortening of thecusps) are frequently discovered when these vessels are opened.
Microscopically : the changes consist of
variations in the thickness of thevein wall caused by dilation in some areas and by compensatoryhypertrophy of the smooth muscle and subintimal fibrosis
in others.Frequently there is
elastic tissue degeneration and spotty calcifications withinthe media (phlebosclerosis).
measure the speed of blood flow and to see thestructure of your leg veins.
to see the anatomy of your veins. During this test, yourphysician injects a dye, properly called contrast, which makes the blood in your veinsappear on an x-ray.
Topical steroids (for stasis dermatitis)
Horse chestnut seed extract
If cellulitis is suspected
empiric therapy (topical antibiotic) with coverage forS. aureus and Streptococci.2.SURGICAL
Injects a chemical into your affected veins
The chemical scars veins from theinside
abnormal veins can then no longer fill with blood. Blood that wouldnormally return to the heart through abnormal vein returns to the heart throughother veins.