A venous leg ulcer is a complication of untreated varicose veins. These varicose veins might be visible on the surface. They also might be hidden under the surface as “hidden varicose veins”.
An impending leg ulcer is a skin change at the ankle that is going to become a leg ulcer. However, an impending leg ulcer can be cured and a leg ulcer prevented. The way to do this is to follow the Whiteley Protocol. Patients need to have a venous duplex ultrasound scan performed by a specialist clinical vascular scientist.
Impending leg ulcer secondary to recurrent varicose veins and perforators
This will reveal varicose veins and hidden varicose veins. Once these have been identified, the Whiteley Protocol then determines the optimal treatment of the veins. When these veins have been treated, and the reflux prevented, the visible varicose veins will disappear and a leg ulcer will be prevented. Eventually, the brown staining will also fade.
This patient is a 69-year-old lady. She had her right leg varicose veins stripped many years ago. As we now know, stripping allows veins to grow back again. In addition, doctors who do their own scans or who strip veins, rarely have the skills to treat incompetent perforating veins.
This lady presented with recurrent varicose veins, swollen right ankle and brown skin changes at the ankle. These brown skin changes are called haemosiderin. The swelling and the haemosiderin are due to recurrent varicose veins. In the middle of the haemosiderin is a white area, called “atrophie blanche”. This means an area of white skin that is dying. If nothing is done for this lady, she will end up having a venous leg ulcer in this area.
Although some people in the UK will just put compression on this, that will do nothing in the long term.
A venous duplex ultrasound scan shows that she has recurrent varicose veins from the groin, secondary to the stripping. More importantly, she also has three incompetent perforators hidden under the haemosiderin that cannot be seen from the surface. Only a venous duplex ultrasound scan will show these hidden varicose veins.
Endovenous laser of the varicose veins in the groin followed by TRLOP closure of the perforators in the lower leg, will completely cure this lady. Removal of the lumpy veins by phlebectomies and foam sclerotherapy of any remaining veins will stop her problem from returning with a certainty of over 96% per year.
This research based approach is what underlies the Whiteley Protocol. Our 12 year results have been published to show how these patients can be cured from their leg ulcers (see: https://www.ncbi.nlm.nih.gov/pubmed/22833505 ).