Venous ulceration : a clinical and laboratory investigation

Venous ulceration is currently managed in a variety of clinical settings using various methods achieving variable results. No agreement exists advising on management strategies for venous ulceration. The aim of this thesis was to address this deficiency by examining the operative and non-operative treatment of venous leg ulcers.;Colour duplex scanning, ambulatory venous pressure measurements and photoplethysmography were used to define the venous abnormalities described and document the effects on venous haemodynamics of surgical interventions. The non-operative management of ulceration was addressed within a prospective randomised trial comparing four layer and short stretch compression bandages. The effects of saphenous vein surgery on ulcer healing and venous haemodynamics were assessed in limbs with superficial reflux alone or in combination with deep venous reflux. Similarly, perforating vein surgery was studied in limbs with co-existing full length deep reflux. A minimally invasive technique for the correction of popliteal vein reflux was developed.;Colour duplex scanning is recommended to define the underlying venous abnormality and individual ulcer management should be based on these findings. Thus: in the presence of full length deep venous reflux neither saphenous nor perforating vein surgery has a beneficial role; these limbs require compression bandaging. Where compression bandaging is required short stretch or four layer are of equal efficacy but four layer are probably safer in very oedematous or very thin limbs. An alternative multi-layer bandage is described. In limbs with saphenous reflux alone, disconnection of the saphenous system results in rapid ulcer healing without associated compression therapy and an ongoing haemodynamic improvement. Limbs requiring popliteal venous valve reconstruction may benefit from the endovenous technique described.