Leg Ulcer of Venous Insufficiency of Left Lower Extremity 左下肢静脉性溃疡

Venous insufficiency from obstruction, reflux, or calf pump failure leads to the formation of varicosities as well as edema, pain, skin pigmentation, and, in severe cases, ulceration. A diagnosis of venous reflux is established by venous valvular failure with retrograde flow and valve closure times >500 ms in the superficial or perforating veins or >1,000 ms in the deep veins by duplex ultrasound.

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Figure 1. (a) A 40-year-old patient with venous ulcer located over the medial gaiter region of the left lower limb. Circumferential wound bed covered with slough and a fibrinous layer mixed with granulation tissue, surrounded by an irregular sloping edge. (b) The same patient. Five years of prolonged venous insufficiency leads to additional skin changes, with the dermis and subcutaneous tissue becoming indurated and fibrosed, so that the progressive fibrosis leads to a more fragile and atrophic skin surface, with loss of sweat glands and hair follicles. Pain is not severe, which is helped by leg elevation. Extravasation of erythrocytes into the skin occurs, resulting in the deposition of haemosiderin that manifests as brown skin pigmentation. (c) Almost complete healing following 20 months of TANGS herbal treatment. The size of the original wound is evident by the amount of newly formed scar tissue present. (d) A duplex ultasound scanning demonstrates the presence of varicosities and relux of great saphenous vein. There was no arterial diseases.

Figure 1. (a) 一名 40 岁的静脉溃疡患者,位于左下肢内侧绑腿区域上方。不规则伤口床覆盖着腐肉和混有肉芽组织的纤维蛋白层,周围有不规则的倾斜边缘。 (b) 同一病人。五年的长期静脉功能不全已经导致额外的皮肤变化,真皮和皮下组织变得硬化和纤维化,因此进行性纤维化导致皮肤表面更加脆弱和萎缩,汗腺和毛囊丢失。疼痛并不严重,腿部抬高后疼痛减轻。由于红细胞外渗到皮肤,导致含铁血黄素沉积,表皮表现为棕色皮肤色素沉着。 (c) 经过 20 个月的唐氏中医草药治疗后几乎完全愈合。原始伤口的大小可以通过存在的新形成的疤痕组织的数量来证明。 (d) 双重超声扫描显示大隐静脉曲张和回流。未发现动脉病变。

HLQ ointment dressinng bandage applied and covered with elastic compression hosiery. HLQ dressings are changed once daily to mainntain moist, but not wet, wound environment. At each dressing change, the ulcer and surrounding skin should be cleaned using potable water to remove debris, dry skin and dressing material. Meanwhile Tangs oral herbal medicinal granules were administrated two times daily. Venous ulcers commonly become infected. The most frequent microbial organisms include Staphylococcus aureus, Pseudomonas aeruginosa and β-haemolytic streptococci. The systemic antibiotics (e.g. penicillin or macrolide) were used to treat infection as well. The leg should always be elevated when seated but patients should be encouraged to remain active. Once the venous ulcer has healed, it is essential that patients follow simple advice aimed at preventing recurrence. This includes compression stockings for life, skin care, leg elevation, calf exercises and a healthy diet.