An ulcer developed near my ankle 2 weeks after laser and sclerotherapy. Here is a picture: https://www.dropbox.com/s/7a1o1r4ojvbjppk/S.jpg The doctor said it would heal by itself if bandaged for 2 months. Is this true? Shouldn't more be done?
Thank you for the photograph. There are several reasons for this occurring. While rare in the hands of vascular-trained nurses and doctors, there can be small communications between tiny arteries and vein that can push solutions back to the skin instead of away from it. These cannot be seen ahead of time. The second reason can be inexperienced injectors, using too strong a solution and injecting into the space around instead of in the vein. The first scenario would be the most common but still rare.
The circulation in the foot and ankle is not as good as higher in the body and nothing heals as well. I would recommend using Silvadene cream (it's a burn cream) available by prescription and keeping a dressing on it. Your surgeon should remove the black areas when they are softer to allow the healthy tissue underneath to heal upwards. Most likely there will be some scarring but be patient, it will heal.
Published on Jul 11, 2012
First of all, I am sorry that you had that complication from the sclerotherapy. The ulcer will likely heal with compression (ideally at least 20- 30 mmHg), either from a medical bandage that applies appropriate
pressure or with a simple dressing and a compression stocking. Studies show that about 90% of venous ulcers will heal with this treatment. Thank you for including a photo; that was very helpful. Your ulcer is small and that means it should close fairly quickly (likely within the 2 months your doctor predicts).
Published on Jul 11, 2012
That is a bad problem. Has the doctor done an ultrasound of your superficial leg veins? Keep the wound clean and soak the foot in warm epsom salt solution for 20 minutes a day.
Published on Jul 11, 2012
The ulcer might heal by itself, but you'll probably have a big scar. I would say that a wound care clinic should be considered. I would hate for an ulcer like that to get bigger and not heal properly. Also, if the ulcer was because of the procedure, that is really rare, and usually means the procedure was done improperly. Make sure your physician is accredited by the American Board of Venous and Lymphatic Medicine, which houses info for the American College of Phlebology. If by chance he/she is not, then the website has a section to find physicians that are accredited.
Published on Jul 11, 2012
Having an ulcer develop following treatment is not very common. It makes you wonder what else is going on. Simply bandaging the ulcer may help heal the ulcer. However, since you do not know what caused the ulcer in the first place, you may find that your ulcer may recur. What we normally would do is first re-ultrasound your leg to reassess how your treatment to date has gone and to also see what may be the driving force for the ulcer formation. There is also a possibility that your ulcer is not a venous ulcer at all but in fact a chemical burn from your sclerotherapy treatment. That could explain why you developed the ulcer after your treatment. My patients typically come in already with an ulcer and then the treatment makes the ulcer heal. You may want to seek a second opinion from a board-certified vein specialist.
Published on Jul 11, 2012
While you do not say what type of solution was used in the sclerotherapy, it is quite likely the wound (or ulcer) is a result of either the sclerotherapy or the laser treatment. It is difficult to say (based only on your report and the photo you've linked to) whether or not the wound will indeed heal within a two-month time frame. From what I can tell by the photo, the wound looks clean with no signs of infection and minimal erythema. You must bear in mind however that wounds like this need to heal by secondary intention (from the inside out). If the wound is closed, either by manual means (sutured) or by the body ( a scab or superficial cover), there then exists the danger of an abscess forming. This is why you want to be sure you keep the wound clean and covered. I would avoid using anything such as Bacitracin (unless there is genuinely an infection present), as this will actually retard and prevent healing. Your wound is most definitely iatrogenic and as such, your surgeon should ultimately take responsibility for its care.
Published on Jul 11, 2012
You need to have the ulcer monitored to ensure it does not get worse.
Published on Jul 11, 2012
That shouldn't have happened. The sclerotherapy seems to have not been injected into a vein. I would see a dedicated wound care specialist and not return to the physician who performed the bad treatment. If you have additional vein issues, you should consult with a vein specialist who is board-certified and has years of experience/training with the various modalities used in vein treatment.
Published on Jul 11, 2012
If you are not content with the advice your treating doctor gave you, I would suggest you seek a second opinion from an accredited MD who specializes in your problem.
Published on Jul 11, 2012
Hi dear,
I need more information:
1. Is the ulcer on the medial or lateral side of your ankle?
2. Did it star after sclerotherapy or laser?
3. Are you diabetic?
4. What kind of solution was used for sclerotherapy?
5. What does your ultrasound show?
6. Do you have an insufficient perforator vein close to the ulcer?
7. Do you have peripheral arterial disease (PAD)?
8. Is there any pus/infection at the ulcer site?
9. Have you had a venous ulcer or leg ulcer before?
10. Have you had phlebitis (inflammation of veins)?
11. Have you had a deep venous ulcer before?
12. What is your height and weight?
13. Do you have heart disease?
14. Has your doctor checked your arteries?
15. Do you have Claudication ( cramp) when you walk?
16. Any other disease(s)?
Compression stocking helps if it is a venous ulcer or post sclero-therapy ulcer. Try to communicate more with your doctor, and express your concerns. If you do not get what you are looking for, seek a second opinion.
Published on Jul 11, 2012
Time is in essence. I agree with the doc.
Published on Jul 11, 2012
A post-sclerotherapy ulcer is sometimes difficult to heal. Cleaning it and compression are the mainstays of treatment, and it could take months to heal. Other things to consider would be a venous evaluation for reflux, if this has not been done already. If there is any underlying reflux, you should have it treated. Also, sometimes if the ulcer is small, it can be primarily excised and closed. There are many topical agents that can be applied to the ulcer, such as algicel, hydrogel, silvadene and other gels. An unna boot can work as well since it has zinc and calamine.
Published on Jul 11, 2012