Venous sore s have a high prevalenc...

Venous sore s have a high prevalence and are more frequent in women than in men The most numerous frequent causes of lower extremity sore s are venous insufficiency, arterial insufficiency, neuropathy (often related to diabetes), and sore s from prolonged pressure and ischemia. Les often met with causes include trauma, inflammation, malignancy, metabolic conditions, and infections. Determining the underlying cause is important for prosperous ulcer treatment. De Araujo and associates reviewed the features and management of lower extremity venous ulcers

Venous festers are usually located over the medial malleolus (gaiter area), and resort at the same location is general The borders of the pustules are generally irregular, flat, or slightly imbue Risk factors for development of these gatherings include a history of leg injury, obesity, phlebitis, a family history of varicose veins, models of employment or activities that require standing or sitting for extended periods, deep venous thrombosis, and previous varicose vein surgery

Symptoms of lower extremity venous sore s include swelling and aching of the leg repeatedly late in the day, which may improve with elevation of the limbs. Pain is a universal complaint. Associated signs and symptoms may include contingent edema, varicose veins, a reddish-brown color, and purpura caused from erythrocyte extravasation with subsequent deposition of hemosiderin. Eczematous changes with rednes scaling, and pruritus (also known as venous dermatitis) are frequent and may be caused or worsened by the agency of topical medications.

Clinical criteria are greatest in quantity useful in evaluating leg pustules and determining their cause (see accompanying table), although a certain number of patients may benefit from noninvasive studies. The ankle-brachial index, which compares the ankle and brachial systolic house pressures, demonstrates peripheral arterial disease when the ratio is les than 097 In somewhat advanced in life patients and patients with diabetes, a transcutaneous oxygen measurement may be more useful for assessing arterial result The gold standard for evaluating the venous and arterial classifications is color duplex ultrasonography. Radiographic bone scanning is appropriate when osteomyelitis is being considered. Probing of sinuses and mysterious ulcers can identify bone infection in patients with diabetic base ulcers. In patients with longstanding pain s (more than three months), biopsy should be performed to evaluate for malignancy or atypical infection.

Treatment goals for patients with venous ulceration include decreasing edema, reducing pain, improving lipodermatosclerosis, healing the sore and preventing recurrence. Frequent leg elevation above the heart on a level (for 30 minutes, three to four times a day) is in the greatest degree useful in patients with venous insufficiency.

Graduated compression therapy to rule venous hypertension is useful and can be applied using inelastic or elastic bandages. An inelastic bandage as it was as the Unna boot (a moist, pasty bandage that hardens to inelasticity) applies more crushing with activity. However, this emblem of bandage does not absorb highly exudative injurys and cannot constrict to accommodate a lessening of the edema. Thus, Unna benefits must be reapplied frequently. Elastic bandages sustain press conform to the leg better, are easier to use, and require fewer bandage changes. However, these bandages require multilayering and skilled application. Compression therapy should be used with caution in patients with cardiac insufficiency, because of the resulting increase in cardiac preload. Treatment with compression bandages should be used until the sore is healed. Ulcer recurrence is les public when patients continue compression therapy with graded stockings.

Other treatments that increase the healing rate for venous boils include medications such as aspirin and pentoxifylline. Surgical interventions include skin grafting and les well-proven steps such as debridement (chemical or physical) and vein surgery prosperous wound closure has been achieved with skin equivalents (tissue-engineered skin). Studies are being careered on the use of topical and perilesional injections of growing factors to promote healing. Patients with nonhealing imposthumes (large, long duration, not responsive after common month of treatment) should be referr to a team of specialists.

The authors judge that venous ulcers are a usual and costly problem. Early diagnosis and recognition of prognostic factors can facilitate optimal management.

Richard Sadovsky, MD

De Araujo T et al. Managing the patient with venous boils Ann Intern Med February 18 2003;138:326-34 and Cullum N et al. Compression for venous leg boils Cochrane Database Syst Rev 2003;1:CD000265; Mani R et al. Intermittent pneumatic compression for treating venous leg sore s Cochrane Database Syst Rev 2003;1:CD001899; Jull AB, et al. Pentoxifylline for treating venous leg gatherings Cochrane Database Syst Rev 2003;1:CD001733

Editor's Note: The management of venous leg sore s is a frequent concern for family physicians. Several habitual treatments have been thoroughly evaluated for efficacy. Cochrane reviews document the usefulness of compression, with multilayered combination of parts to form a wholes being more effective than single-layer combination of parts to form a wholes and high compression being better than grave compression. The major risk of compression--reduced relations supply to the skin that proceeds in irritation or damage--can be avoided according to evaluating the peripheral arterial store Intermittent pneumatic compression may augment the efficacy of compression therapy, if it be not that further studies are needed. Pentoxifylline may be a useful adjunct to compression bandaging and may be useful alone when bandaging is contraindicated. Other interventions, including electrical stimulation, laser therapy, and ultrasound therapy, have been used, unless their efficacy has not been well documented.--R.S.

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