▲The outpatient follow-up 1 month after the operation showed that the original ulcers had completely healed from different angles.

(Photo courtesy/Cai Chenggen)

Text/Cai Chenggen

A 45-year-old man came to the outpatient clinic. He reported that the wounds on his lower limbs had been repeatedly inflamed and could not heal for nearly 10 years.

I was diagnosed with vasculitis before, so I have been taking steroids and other drugs for a long time to control the condition, especially on the feet and ankles, I can see that many gauzes are used to cover the wounds, and after removal, there are ulcer wounds of different depths , and it was very painful, even the outpatient nurse could not touch the wound with a cotton swab, and he still gently brushed the wound by himself.

Appearance shows that the skin below the calf is darker in color, and slight edema can be found by pressing the skin. Therefore, further vascular ultrasound examination found that the iliac vein was blocked and the venous valves of both lower extremities were disabled, resulting in severe venous reflux. Therefore, arrangements were made. date surgery.

As a result, 2 days before the operation, the bacterial infection of the wound spread and caused bacteremia, which caused multiple organ failure, and the condition was stabilized after vigorous treatment in the intensive care unit.

Please read on...

After his liver and kidney index stabilized, he continued to arrange for minimally invasive vascular interventional surgery. The blocked iliac vein was opened with a venous stent, and the deformed varicose vein was closed with venous gel. The problem was completely treated, and because of the small wound and quick recovery, I was discharged from the hospital 2 days after the operation.

According to the statistics of chronic lower extremity ulcer wounds, up to 70% of them are caused by venous problems.

The most common locations are below the ankle and the calf. If the skin is dull and edematous, it is highly reasonable to suspect that it is caused by venous insufficiency.

At this time, the venous return status of the lower body (from the pelvic cavity to the soles of the feet) must be checked in detail with instruments, and the blocked or refluxed veins should be found out, and different treatment methods should be used for different positions of the veins, so that the lower body can be improved. The venous blood can flow back to the heart smoothly.

The continuous poor healing of lower limb wounds is due to blood stasis, just like when a balloon is filled with water, if a hole is pricked with a needle, the water inside will continue to flow out.

By the same token, when the lower extremity begins to have a wound, interstitial fluid will continue to leak out, which is the characteristic of a typical venous ulcer wound.

The treatment method will be compression therapy and medication. In addition, more aggressive minimally invasive surgery can be considered to block the local reflux vein and open the blocked blood vessel at the source. This can speed up wound healing and greatly reduce the chance of recurrence.

(The author is a Cardiovascular Surgeon at Yida Cancer Hospital)

▲The patient's lower limbs were covered with gauze to cover the ulcer wound (left in the picture); after the gauze was removed, the ulcer wound was of different depths and the surrounding area was red and swollen (right in the picture).

(Photo courtesy/Cai Chenggen)

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keywords

• multiple organ failure

• Steroid

• health care

• Bacterial infections

• Vasculitis

• drug control

• lower extremity vasculitis

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