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A venous ulcer tends to occur on the medial side of the leg, typically around the medial malleolus in the 'gaiter area' whereas arterial ulcer tends to occur on lateral side of the leg and over bony prominences. A venous ulcer is typically shallow with irregular sloping edges whereas an arterial ulcer can be deep and has a 'punched out' appearance.
For venous stasis ulcers, the paste-impregnated wrap is covered by an elastic layer, generally an elastic wrap ("ACE" bandage) or self-adherent elastic bandage such as Coban; this is referred to as a 2-layer compression bandage. An alternative treatment is a 4-layer, graduated compression wrap (Pro-Fore is an example).
Potential complications of venous stasis are: Venous ulcers; Blood clot formation in veins (venous thrombosis), that can occur in the deep veins of the legs (deep vein thrombosis, DVT) or in the superficial veins; Id reactions [1]
Venous ulcers are common and very difficult to treat. Chronic venous ulcers are painful and debilitating. Even with treatment, recurrences are common if venous hypertension persists. Nearly 60% develop phlebitis which often progresses to deep vein thrombosis in more than 50% of patients. The venous insufficiency can also lead to severe hemorrhage.
Although the FDA has approved treatment for at least one company using TCOT for the following indications, [2] most of the interest in TCOT at present concerns diabetic foot ulcers, venous stasis, and decubitus ulcers. Skin ulcers due to diabetes; Skin ulcers due to venous stasis; Decubitus ulcers (bed sores, pressure sores)
Stasis dermatitis is diagnosed clinically by assessing the appearance of red plaques on the lower legs and the inner side of the ankle. Stasis dermatitis can resemble a number of other conditions, such as cellulitis and contact dermatitis, and at times needs the use of a duplex ultrasound to confirm the diagnosis or if clinical diagnosis alone is not sufficient.
A significant part of a phlebologist's work is involved with the treatment of superficial venous disease, frequently of the leg. Conditions often treated include venous stasis ulcers, varicose veins and spider veins (telangiectasia).
The distal veins are removed following the complete ablation of the proximal vein. This treatment is most commonly used for varicose veins off of the great saphenous vein, small saphenous vein, and pudendal veins. [60] Follow-up treatment to smaller branch varicose veins is often needed in the weeks or months after the initial procedure.
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