Kamal Yousuf, Syed Sajid Hussain, Yasmeena Khan.
Chronic venous ulcers.
J Pak Assoc Derma Jan ;10(3):41-3.

Ulcers of the lower leg secondary to venous insufficiency account for some 85% of all leg ulcers. The proper venous drainage of a leg requires three sets of veins. Thee deep vein surrounded by muscles, the superficial veins, and the veins connecting these two - the perforating or communicating veins.

CASE REPORT: 42 years old smoker presented with ul-cers on left leg along medial side of foot around medial malleolus and also small ul-cers around lateral malleolus since last 20 years. Over last 20 years he was seen by physicians, surgeons and dermatologist. He was on & off kept on steroids, antibiotics and regular dressings but no improvement achieved. Presented in LNH Dermatology Consul-tation Clinic with above symptoms, away from work since last 2 yeas because of re-current infection & pain. Referred to vascular surgical department of LNH. On examination there was no obvious varicosity or arterial insufficiency but on careful palpitation he had incompetent sepheno-femoral junction with very strong cough reflux going upto midcalf. Trendelenburg test was strongly positive. Hand hold Doppler study done in clinic showing very strong regurgitation of venous blood in superficial venous system. The perforators along the medial side of calf were also found incompetent. He was offered surgical treatment and high flush ligation & stripping and multiple avulsion of vericose veins along long sephenous system was done. The perforators veins along medial side of calf were ligated.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com