Foam treatment of venous leg ulcers

This chapter discusses the foam treatment of venous leg ulcers. When leg ulcers caused by venous insufficiency develop, surgery becomes the dominant method of treatment. Foam sclerotherapy is performed in the office setting, since neither anesthesia nor analgesics are required. The patient with the venous ulcer undergoes a standing lower extremity ultrasound examination to map the normal and pathologic anatomy, including refluxing veins and exit and re-entry perforating veins. As the foam is injected, manual displacement of the foam can be accomplished using the ultrasound probe or the treating physician's hand. Prior to the development of ultrasound imaging, foam direction was accomplished by noting crepitus. Foam is directed into the refluxing saphenous or accessory saphenous veins and pushed to groin level. If foam is seen to enter the deep system via a perforator, the patient is asked to flex and extend the foot forcefully to contract the gastrocnemius- soleus muscles. Foam sclerotherapy reaches its highest pinnacle of success in treating venous leg ulcer. This is easily explained by the fact that the tangle of pressurized veins that cause and perpetuate the leg ulcer are closed by the actions of the foamed sclerosant.

Duke Scholars

Author Cynthia Keene Shortell Surgery, Vascular and Endovascular Surgery