Saturday, 14 July 2012

Curable venous ulcer delayed by inappropriate referral

This patient came to The Whiteley Clinic with a leg ulcer on the right leg, with brown skin staining around the lower leg and visible varicose veins on standing.

Despite having a classic venous leg ulcer, he was referred to a plastic surgeon who charged him to say that the ulcer wasn't malignant - and despite several hundreds of pounds, no treatment was suggested or offered!!
Venous Ulcer of Left lateral (outer) ankle - brown stains typical of venous disease clearly seen on leg
Also varicose veins clearly seen - although not always present in venous ulcers
Purple pen mark above ulcer marking site of Incompetent Perforator Vein
When he came to The Whiteley Clinic, a consultation and examination revealed a previous vein operation about 10 years ago using the old "Stripping" method which we now know allows veins to grow back again - causing the same problem to recur (

Duplex Ultrasound report - The Great Saphenous vein has been stripped before - but has regrown in the mid portion.
The Small Saphenous Vein is huge (14mm) and there is reflux in Anterior Accessory Saphenous Vein and multiple incompetent perforators.
Patient can be cured by EVLA and TRLOP under local anaesthetic. 
The combination of brown discolouration of the skin at the ankle, a little swelling o the ankle and a leg ulcer made it virtually creating the problem was a venous leg ulcer - and therefore curable in most cases using The Whiteley Protocol(TM).

A venous duplex ultrasound showed that the Great Saphenous Vein had partially grown back again causing problems, and further venous reflux in the Small Saphenous Vein, Anterior Accessory Saphenous Veins and 4 incompetent Perforating Veins were causing the leg ulcer (see "Understanding Venous Reflux - The Cause of Varicose Veins and Venous Leg Ulcers").

All of these veins can be cured under local anaesthetic with a combination of Radial Firing EVLA for the long veins and TRLOP of the incompetent perforating veins.

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