Pathophysiology: Any cause of venous insufficiency

1. Valvular disease
   • Varicose veins
   • Deep vein reflux
   • Communicating vein reflux
2. Outflow tract obstruction
   • Post DVT
3. Muscle pump failure
   • Primary - stroke, NM disease
   • Secondary - stiff ankle

Approach

• Expose from groin to toes
• Preserve dignity

1. Inspect

   

   • Common in gaiter area
   • Size varies
   • Edge sloping, pale purple/brown in colour
   • Surround pigemtnation (lipodermatosclerosis)
   • Oedema, spider veins, telangectasia
2. Palpate
   • Temperature - may be warmer than rest of leg

Completion

• Examine limb for varicose veins
• Measure ABPI (should be >0.8 before compression bandaging can be used)

Management of venous ulcers

1. Non-surgical
   • 4 layer compression bandaging: (1) non-adherent dressing over ulcer + wool bandage (2) crepe bandage (3) blue-line bandage (4) adhesive bandage to prevent other layers from slipping
   • Elevation of leg
   • Once healed, compression stockings
2. Surgical
   • Biopsy - may be Marjolin's ulcer
   • Split skin graft considered with excision of dead skin and graft attached to healthy granulation tissue
   • Surgery to varicose veins, if cause