A 55-year-old woman has a venous ulcer above the medial malleolus. Duplex ultrasound confirms incompetent perforators and great saphenous vein reflux. Her ABPI is 0.92. The Venous Clinical Severity Score (VCSS) is used. Which pathophysiological mechanism primarily drives venous ulcer formation?
- A Sustained venous hypertension causing pericapillary fibrin cuffing and white cell trapping ✓
- B Arterial insufficiency with capillary ischaemia
- C Lymphatic obstruction preventing tissue fluid drainage
- D Peripheral neuropathy causing repetitive trauma
Correct answer: A. Sustained venous hypertension causing pericapillary fibrin cuffing and white cell trapping
Explanation
Venous ulcers result from chronic venous hypertension (reflux or obstruction), which causes capillary distension, leakage of fibrinogen (forming pericapillary fibrin cuffs), and white cell trapping and activation. This results in local tissue hypoxia, inflammation, and skin changes (lipodermatosclerosis) culminating in ulceration. The ABPI of 0.92 is normal, excluding arterial aetiology. Neuropathic ulcers typically occur on pressure points, not the gaiter area.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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