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INTRODUCTION

The most vexing complication of venous insufficiency—the ulcer—poses three levels of burden:

First, there is a PHYSICAL burden. As if the heaviness and aching of the legs were not enough, breakdown in the skin is a debilitating misery. The continuous drainage, odor, and discomfort of a nonhealing ulcer greatly limit activity. Persons who also have problems of flexion and strength from arthritis or other movement-limiting problems are often unable to care for this complication despite their best efforts.

Then, a PSYCHOLOGICAL burden is added. The endurance of anyone suffering from a long-standing venous ulcer is severely tested. Embarrassment from an unsightly ulcer leads to withdrawal from social encounters and work environments. Discouragement turns into despair when even professional caregivers cannot provide rapid relief. The venous ulcer can become a lifestyle-changing affliction.

Thirdly, the liability of ECONOMICS casts a shadow on the most optimistic outlook. The slow rate of improvement of a venous ulcer, even with optimal treatment, exacts a serious financial burden on the individual or on the provider because of limitations of work, the professional services required, as well as the materials and devices necessary. Management of venous ulcers in the United Sates annually costs many billions of dollars, factoring in both lost working days and direct costs of treatment [1].

The curse of the venous ulcer has been known since ancient times. The gnawing distress proves ugly, stubbornly resistant to treatment, and thoroughly disheartening. They produce a long-lasting physical, emotional, and social burden. Even with absolute power, King Henry VIII could not muster the resources to control a chronic leg ulcer. It was almost certainly venous in origin, the result of an injury incurred during joisting decades before. The king’s obsession with his persistent throbbing and smelly lesion is described further in Chapter 22.

It is not uncommon for a specialist in vascular diseases to be presented with a venous wound that is far advanced in width and depth, even affecting the muscle and extending down to the bone. Too often, there has been longstanding resignation to the problem by the patient after a protracted and unfruitful series of medical and lay interventions, occurring over many years. These long-enduring persons have usually tried an endless number of salves, soaks, dressings, acupuncture, and other remedies in a desperate attempt to heal the ulcer. In many instances, skin grafts have been performed; they often fail unless the underlying edema is also controlled.

Yet, it is not necessary to become resigned to this futile outcome. Advances in understanding the cause of the venous ulcer and in its treatment now justify realistic optimism for healing. Despite their typically slow rate of healing, these ulcers will respond to fairly simple measures, perseveringly rendered. Decades ago, clinical investigators determined that nearly all ulcerated extremities could be healed by the pressure bandaging combined with ordinary wound care...

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