, 2011, Vol 7, No 2
Recurrent ulcers in a patient with post-thrombotic syndrome
and low molecular weight heparin(Musani, 2010; Roche-Nagle, 2010).The aetiological study did not showup the condition of thrombophilia.Up until 2008 the patient hadno significant symptoms and only intermittently used elastic compressionstockings. However, after a minor accident (hitting his leg on a chair),he started having recurrentmalleolar ulcers.Leg ulcers can be a challenge toheal, especially when the underlyingproblem is caused by post-thromboticsyndrome (PTS). PTS is presentin 5–10% of cases of venoushypertension and treatment iscomplex with many possible medicaland surgical options (Saedon andStansby, 2010; Kahn, 2011).PTS is the occlusion of the deepvascular system with weakenedrevascularisation, associated withmoderate insufficiency of the poplitealvein and insufficiency of the leg’sperforating veins (Hencke, 2010).The superficial venous system usually appears without reflux, becominginsufficient only in the later phase of the disease (Eklof, 2004; Perrin, 2005;Albino, 2008).A Cochrane review described PTSas a long-term complication of deepvein thrombosis (DVT), characterisedby chronic complaints, swelling, andskin changes in the affected limb. Onein three people with DVT developpost-thrombotic complications withinfive years (Kolbach, 2003). Due toits prevalence (20–50% of patientsdevelop PTS within one to two yearsof symptomatic DVT) and chronicity,PTS is costly to society and is a causeof substantial patient morbidity (Kahn,2004; Vasquez, 2010).
A professional waiter (male, 32 yearsold) had an occupational accident in2004 resulting in a bone fracture to the left leg. After surgery, DVT of thepopliteal femoral developed. This wasconventionally treated with elasticcompression stockings to prevent fluidfrom pooling in the ankle (oedema),
Pereira Albino is Vascular Surgeon o the H. Lusíadas-HPP, Lisbon, Portugaland invited Proessor o Surgery o the FCM, New University o Lisbon; NunoMeireles is Vascular Surgeon o the H. Lusíadas-HPP, Lisbon, Portugal; JoséAlves, Eliana Rosa, Margarida Lino, Andreia Porfrio, Nadia Cardoso, RosaSantos and Fernando Barros are Nurses, Ambulatory Department,H. Lusíadas-HPP, Lisbon, Portugal
The patient was treated withinadequate compression
and many other dressings at a clinic in Lisbon.Silver-based (Aquacel
Ag, ConvaTec)and hydrocolloid dressings wereused, combined with pentoxifylline(for intermittent claudication) andmicronised diosmin (Daflon). However, the ulcer remained unhealed for abouteight months.The clinical situation was aggravated in
Figure 2. Healed ulcers on 07/07/2010 ater our weeks o honey treatment.Figure 1. Inected ulcers at frst review on 21/05/2010.
Honey CR.indd 217/06/2011 09:41