​Surgery - Venous leg ulcers

​Surgery - Venous leg ulcers
Introduction 
Eighty to eighty-five percent of leg ulcers are caused by venous insufficiency, which results in lower limb ulceration.

Etiology 
The consequences of venous hypertension, stemming from either superficial or deep venous incompetence, include heightened tissue oedema, compromised microcirculation, and ultimately, tissue necrosis and ulceration. The "fibrin cuff" of tissue, white cell adhesion, and/or persistent inflammation due to ischaemia-reperfusion injury are some of the theories regarding the processes.

Epidemiology 
Leg ulcers affect 1% of people in affluent nations, placing a significant strain on healthcare resources as people age and are more common in women than in men.

History 
The symptoms of chronic venous insufficiency include weight gain, hurting legs, ankle swelling, skin abnormalities, itching, and ulceration. Identify the risk factors for peripheral vascular disease or deep vein thrombosis.

Examination 
A venous ulcer's typical location is in the "gaiter area," which is above the medial malleolus. The majority of the time, ulcerations are shallow, have sloping margins, and are surrounded by pigmentation, atrophie blanche, varicose eczema, and lipodermatosclerosis. While the patient is standing, look for varicose veins. Find the ankle-brachial pressure index (ABPI) to check for peripheral artery disease that may be present concurrently. Vascular, diabetic, neuropathic, infectious, neoplastic, and arterial ulcers are among the differential diagnoses.

Investigational studies
Ankle-brachial pressure index (ABPI): ABPIs should be used to screen all patients for vascular disease. Modified compression may be an option for patients with an ABPI of 0.5–0.8, while patients with an ABPI of less than 0.5 should be referred or evaluated for the care of arterial insufficiency first. Microbiology swab: If discharge, erythema, cellulitis, or pyrexia are indications of an infection. If cytology or a biopsy raises any doubts regarding cancer.

Management
Multiple layers of compression, such as the Charing Cross four-layer bandage made of wool, crepe, elastic, and cohesive bandages, are used to treat venous hypertension. suggestions for moving and elevating the legs. Compression stockings stop recurrence after healing. Antibiotics ought to be saved for cellulitis-surrounded infected ulcers. Pentoxifylline might be a useful supplement. It has not been demonstrated that topical treatments, regular systemic antibiotics, or certain types of dressings enhance healing. Surgery: Varicose veins can be treated with endovascular or open surgery. According to the ESCHAR (Effect of Surgery and Compression on Healing and Recurrence) study, superficial vein surgery helps to prevent recurrence once it has healed but does not accelerate the healing process by compression. Skin grafting might be suitable for some patients.

Complications 
Chronic wounds, infection, recurrence, and the emergence of cancer in ulcers that have been open for a long time (Marjolin's ulcer).

Prognosis 
Frequently a persistent issue with erratic recovery times. Recurrence rates after healing are roughly 25% after a year and 33% after 18 months.