Infected, and huge venous ulcer
A huge, circumferential venous ulcer that covers almost two thirds of the left calf, infected, in a patient in his 50s, very obese but yet active, no history of DVT, no medical history, on ultrasound scan: 5 huge incompetent perforators under the active ulcer + Incompetent GSV of (31 mm) and SSV 18 (mm), and intense subulcer venous plexus. Deep venous system is competent and compressible with no scars seen. APG normal.
What would be the best way to manage and treat? .. Thank you
I would prefer endovenous ablation of the GSV and SSV (with such large veins I would use a radial laser) and TRLOP of perforators – then 8 weeks or so later, foam sclerotherapy to sub-ulcer plexus.
However, some might prefer the TIRS technique and use only foam – but such a large amount of reflux in big veins would probably result in early recurrence and the need for more foam.