بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. Mr. NASSER EL Said FRCS Consultant Vascular Surgeon Maadi Armed Forces Hospital

3. Leg Ulcer Classification Vascular → arterial → Lymphatic → Venous Infection → Chronic Osteomyelitis TB,Syphilis SystemicDM, Sickle cell anemia Neoplastic Sq. cell carcinoma , Melanoma Metastatic Traumatic Radiation

4. Classification

5. Pathogenesis Venues 40% arterial 20% others 40%

6. Venous UlcerPathogenesis :- Venous hypertension ------ 1 ry reflux 70% ( genetic) ------ 2 ry reflux 30% (DVT) W.B.C activation V. Hypertension Or Fibrin Cuff Dermatolibosclerosis ulceration ulcer

7. 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) ------- Jundice (tumour ) Local exam Site , Size , Shape and Edge.

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

9. Investigation • Duplex Study • Arteriography • Plethysmogaphy Ascending • Phlebography Descending • CT Scan • Isotope – scanning • MRA

10. Treatment General Treatment Conservative Topical Therapy Surgical Reconstructive Debridement Skin graft

11. Treatment Conservative • Bed rest + limb elevation ( effective therapy but impractical ) • Drugs-------- Zinc ------- Pentoxiphylline ------- I.v. prostaglandin

12. Treatment • Gradient compression • =Dynamic ( unna boot ) • =Static: • - Stocting , • - Multilayered elastic wrapped dressing

13. Treatment • Sclerotherapy: Foam injection

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

15. Treatment • Arterial bypass. • Debridment. • Skin Graft.

16. THANK YOU