VENOUS ULCER

• An ulceration of the skin caused by chronic venous insufficiency. Classically develops superior to the medial ankle. Often associated with skin changes ( hyperpigmentation) and unilateral oedema
• Commonest ulcer of the leg
• Basic cause is the abnormal venous hypertension in the lower third of the leg, ankle and dorsum of the feet
• Also known as varicose ulcer, post-thrombotic ulcer, gravitational ulcer etc.

• Ulceration may be associated with demonstrable varicose veins
• Ulceration may follow thrombosis and phlebitis in the deep and perforating veins
• Poor exchange of oxygen and nutrients causes necrosis of tissues
• Alteration of blood vessels at arterial, capillary, and venous levels may affect cellular processes and leads to ulcer formation

• Ulcer appears open, inflamed, and sore which may be draining or covered by a dark crust
• Unevenly shaped borders
• Surrounding skin: shiny, tight, hot, and discoloured
• Usually only mild pain , pruritic
• If infected- foul smelling pus discharge

Examination of Ulcer

• Shape: Generally vertically oval in shape
• Number: may be more than one in number
• Position: an ulcer on the medial malleolus of a lower limb which shows varicose veins, is obviously a venous ulcer
• Edge: Sloping edge is seen in healing venous ulcer
• Floor: Healthy and healing- red granulation tissue, slowly healing- pale and smooth granulation tissue
• Surrounding area: very often eczematous and pigmented
• Tenderness: varicose ulcer may or may not be tender

• Ascending functional phlebography or venography
• Venous doppler study

Conservative treatment

• Elevation of the affected limb
• Passive movements to maintain the mobility of the foot and ankle
• Active movements of calf muscles
• Compression
• Effective antibiotic from the culture report
• NSAIDs
• Exudative ulcer with poor granulation tissue requires daily cleansing and dressing
• After healing compression stockings

 Surgical Treatment

• Incompetent perforators and varicose veins may be treated by surgery or sclerotherapy
• Larger ulcers- split skin graft

Ayurvedic Treatment

Internal medicines

• Guggulutikthaka Kashaya
• Manjishtadi Kashaya
• Guggulutikthaka Ghritha
• Sonitamrutha Kashaya
• Kaisora guggulu
• Vilwadi gutika
• Arogya vradini vati
• Guggulupancha pala choorna

Procedure

• Raktha mokshana
• Bandage – Vipareetha malla taila

• Kshalana - Triphala Kashaya , karnja kashaya, Nalpamaradi kashaya
• Lepa – Nimbachoorna+ Madhu +Ghritha +Ttila
• C&D - Jathyadi Gritha
• Dhara – Karaskara ksheera , Paranthyadi taila