ABSTRACT

In the majority of cases, venous ulcers can be managed by complete investigation, surgical intervention to treat incompetent superficial veins and perforating veins where appropriate, and compression bandaging. In a number of cases, these measures may fail to heal the ulcer or ulcer healing may be very slow. There are a number of reasons for this. Patients with very large or long-standing ulcers are the most difficult to heal and, with the progression of time, increasing age and immobility may prove resistant to conventional treatment. In patients with coexisting venous and arterial disease, it may not be possible to use the highest levels of compression because of the risk of causing skin necrosis of bony prominences. In these cases, skin grafting or vascular flaps may be considered. This subject has been recently reviewed in the Cochrane Database.1