A 65-year-old woman presents with a non-healing ulcer on the medial aspect of the right lower leg above the medial malleolus. Duplex ultrasound shows deep venous insufficiency (venous reflux in the popliteal and long saphenous veins). ABIs are 0.95. What is the first-line treatment?
- A Immediate venous surgery (SEPS — subfascial endoscopic perforator surgery)
- B Skin grafting of the ulcer bed after debridement
- C Four-layer compression bandaging providing 40 mmHg ankle pressure ✓
- D Warfarin anticoagulation to treat the underlying venous thrombosis
Explanation
Chronic venous ulcers (characterized by medial malleolar location, shallow, irregular border, eczematous skin, lipodermatosclerosis) are primarily treated with compression therapy. Four-layer compression bandaging (applying graduated compression of 40 mmHg at the ankle) is the gold standard first-line treatment, achieving healing in ~70% of venous ulcers within 24 weeks. ABI must be >0.8 before applying full compression. SEPS and saphenous ablation may reduce recurrence after healing. Surgical debridement or skin grafting may be used for recalcitrant ulcers after compression therapy failure.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.