Classification Vascular arterial Lymphatic Venous Infection Chronic Osteomyelitis

Classification Vascular → arterial → Lymphatic → Venous Infection → Chronic Osteomyelitis TB, Syphilis Systemic DM, Sickle cell anemia Neoplastic Sq. cell carcinoma , Melanoma Metastatic Traumatic Radiation

Classification

Pathogenesis Venues 40% arterial 20% others 40%

Venous Ulcer enesis : - Venous hypertension ------ 1 ry reflux 70% ( genetic) ------ 2 ry reflux 30% (DVT) W. B. C activation V. Hypertension 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.

tions l General: C. B. P, W. B. C, E. S. R, C. R. P…. Specific: according to the primary diagnosis Vascular C&S Neoplastic l Duplex Biopsy

Investigation l l l Duplex Study Arteriography Plethysmogaphy Ascending l Phlebography Descending l l l CT Scan Isotope – scanning MRA

Treatment General Treatment Conservative Topical Therapy Surgical Reconstructive Debridement Skin graft

Treatment Conservative l l 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 l Sclerotherapy: Foam injection

Treatment Surgical l V Vs surgery: • High tie • Stripping • Perforators ligation • Multiple avulsions

Treatment l l l Arterial bypass. Debridment. Skin Graft.