3. Classification Vascular → arterial → Lymphatic → Venous Infection → Chronic Osteomyelitis TB,Syphilis Systemic DM, Sickle cell anemia Neoplastic Sq. cell carcinoma, Melanoma Metastatic Traumatic Radiation

4. Classification

5. Pathogenesis Venues 40% arterial 20% others 40%

6. Venous Ulcer Pathogenesis :- Venous hypertension ------ 1 ry reflux 70% ( genetic) ------ 2 ry reflux 30% (DVT) W.B.C activation V. Hypertension Or Fibrin Cuff Dermatolibosclerosis ulceration ulcer

7. Diagnosis History up to 35% of the adult population have some of the following V. Disease, DM, T.B, tumour ……… etc. General exam ------ Anaemia (healing) ------- Jundice (tumour ) Local exam Site, Size, Shape and Edge.

8. Investigations General: C.B.P, W.B.C, E.S.R, C.R.P…. Specific: according to the primary diagnosis Vascular Duplex Infective C & S Neoplastic Biopsy

9. Investigation Duplex Study Arteriography Plethysmogaphy Ascending Phlebography Descending CT Scan Isotope – scanning MRA

10. Treatment General Treatment Conservative Topical Therapy Surgical Reconstructive Debridement Skin graft

11. Treatment Conservative Bed rest + limb elevation ( effective therapy but impractical ) Drugs-------- Zinc ------- Pentoxiphylline ------- I.v. prostaglandin

12. Treatment Gradient compression =Dynamic ( unna boot ) =Static: - Stocting, - Multilayered elastic wrapped dressing

13. Treatment Sclerotherapy: Foam injection

14. Treatment Surgical V Vs surgery: High tie Stripping Perforators ligation Multiple avulsions

15. Treatment Arterial bypass. Debridment. Skin Graft.