Classification Vascular arterial Lymphatic Venous Infection Chronic Osteomyelitis TB,Syphilis Systemic Neoplastic DM, Sickle cell anemia

emia 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)
V. Hypertension

W.B.C activation Or Fibrin Cuff

Dermatolibosclerosis

ulceration ulcer

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)

Local exam

------- Jundice (tumour ) 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 Infective Neoplastic

Duplex C&S 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.