60-year-old woman, ambulatory, smoker, no diabetes, no history of surgery or trauma to the leg, no other significant medical history. She developed a small ulcer without any known cause or trauma above the medial ankle. This progressively grew in size over 3-4 months. She presented with a very painful, malodorous ulcer
Diagnosis: Venous leg ulcer. Diagnosis is made by history and clinical exam and ulcer characteristics. Arterial disease was ruled out with clinical exam and vascular studies with ultrasound
The plan included regular visits to the wound center for wound care and compression. Initially, the visits were twice weekly to monitor the response of ulcer, control drainage, and monitor the effect on ulcer pain. Once pain and drainage improved and the ulcer started showing new epithelization frequency of visits was once a week. Throughout treatment sustained compression was applied to the foot, ankle, and whole leg with multilayer compression bandaging once or twice weekly. The patient was educated on how to care for the ulcer and apply a commercial multilayer compression bandage system and she was able to do that at home
The ulcer continued to progressively epithelize. The treatment plan mentioned above and weekly visits were continued to monitor progress. The ulcer epithelized in 4 to 5 months except for a small area 4×4 mm in the lowest part of the ulcer recurred and would not close. The patient was referred to a vascular surgeon who did vein ablation in the same extremity. This area healed immediately after the vein ablation
The patient continued the multilayer bandage until the ulcer was covered with mature skin. At that time patient was transitioned to moderate to high compression stockings.
She required a few more outpatient vein ablations by a vascular surgeon. She was followed periodically for four years. The ulcer remained healed and there was no recurrence. She remained very compliant with wearing compression stockings daily