The patient is an 81 y.o. woman with a 4 year history of an ulcer of her right leg. She has received treatments from a variety of specialists during this time and the ulcer was unsuccessfully grafted ~ 3 months ago. The patient is an asthenic vegetarian but takes multivitamins and there is no evidence of anemia. Her arterial circulation is normal per doppler studies. She is taking doxycline because of purulence but a culture was not done.
O/E: There is a 12 x 8 shallow ulcer over the lower right leg. The foot is warm and a dorsalis pedis pulse was present. There is an early champagne bottle deformity and lymphedema of the affected leg..
Clinical Photos:
Impression: Large venous leg ulcer.
Discussion: The patient, who lives independently with her husband, has mild to moderate cognitive decline and does not seem overly concerned about the ulcer. The ulcer continues to advance in spite of medical attention. Without intensive care, it is unlikely that such a large ulcer will heal. Her case is presented for discussion and therapeutic suggestions.
References:
1. Alavi A et al. What’s new: Management of venous leg ulcers: Treating venous leg ulcers. J Am Acad Dermatol. 2016 Apr;74(4):643-64
2. Alavi A e.al. What's new: Management of venous leg ulcers: Approach to venous leg ulcers. J Am Acad Dermatol. 2016 Apr;74(4):627-40. Alavi A. Et al. J Am Acad Dermatol. 2016 Apr;74(4):627-40; quiz 641-2.
3. Compression bandages or stockings versus no compression for treating venous leg ulcer. Meta-AnalysisCochrane Database Systematic Reviews. 2021 Jul 26;7(7):CD013397. Free PMC article
