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INTRODUCTION

The complications of venous insufficiency arise from jeopardized tissue in the fluid-distended leg. Treatment of complications consists first of redoubling the general efforts already described to reduce venous hypertension and to control edema. Then, each complication is addressed individually.

Chronic venous insufficiency unattended eventually leads to complications that seriously impair the quality of life. Changes in skin, pain, and bleeding are covered in this chapter. The most complex and troublesome of these complications is the venous ulcer, a subject treated separately in Chapter 18. Some descriptions within these two chapters are intentionally redundant.

PATHOGENESIS

In a nutshell, the complications of chronic venous insufficiency are the result of unrelenting excessive hydrostatic pressure caused by defective valves in veins. Serum leaking from the capillaries contains small amounts of protein, most of which is fibrin. Fibrin is the substance of serum that makes up the bulk of a scab when venous blood clots. It is postulated that fibrin particles form a cuff around capillaries and, by acting as a barrier, interfere with the normal exchange of nutrients and gases (including oxygen) between the blood and the cells. The deposits may also choke off the channels for lymph drainage. Intimately involved in this destructive process is inflammation [1]. The release of cytotoxic enzymes may participate as well as localized deactivation of tissue-reparative growth hormone.

The overriding principle of treating complications of venous insufficiency is repeated: wounds do not heal unless the aggravating factor (or factors) is eliminated or at least brought under some degree of control. Efforts to deal directly with the complications while neglecting the role of hydrostatic pressure will prove disappointing.

CELLULITIS

Cellulitis is an acute inflammation of the skin and underlying soft tissue caused by infection [2]. It is recognized by bright redness, swelling, tenderness, and increased warmth. Fever with chills may be present as well. Tiny blisters of the skin which break and ooze serum may complicate the picture. Cellulitis warns of a break in the skin through which microorganisms have invaded. In most cases, these are bacteria commonly found normally on skin, namely Staphylococcus and Streptococcus bacteria. Fungi can also be inciting agents of cellulitis.

Cellulitis is not a direct complication of venous insufficiency when the skin is intact. The attending infection from broken skin tends to spread more rapidly if it occurs on water-logged tissue. Obviously, the person with venous reflux disease must assiduously try to avoid insect bites, scratches, tinea pedis, and penetrating injuries in the region. Treatment of such lesions should be attended to promptly.

Typically, the plethoric leg from venostasis has a dark reddish hue when it is in the dependent position. A way to help distinguish the discoloration of venous reflux from the inflammation of cellulitis is by raising the leg. In the former, the redness will ...

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