Q:

The best treatment plan for the patient described in the preceding question should include:

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The best treatment plan for the patient described in the preceding question should include:


  1. Varicose vein ligation and stripping as soon as possible.
  2. Ulcer débridement, vein stripping, and skin grafting.
  3. Ligation of the medial perforating veins.
  4. Transposition of saphenous vein valve
  5. Leg elevation, external Unna boot support, and ambulation without standing.

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E. Leg elevation, external Unna boot support, and ambulation without standing.

DISCUSSION: Operative treatment of venous insufficiency is in most instances an adjunct after failure of aggressive conservative management. Leg elevation, active exercise, and elastic compression form the cornerstones of nonoperative management. The goals of compression are to relieve symptoms and reduce swelling. The indications for superficial vein ligation and stripping are moderate to severe symptoms without other signs of deep venous insufficiency. If ulceration persists despite appropriate conservative management, ligation of the underlying incompetent perforators helps ulcer recurrence, and split-thickness skin grafting provides immediate coverage and healing of the ulcer. The patient must, however, comply with a program of external stocking support and prevention of leg edema since the underlying venous pathophysiology remains and ulcers tend to recur.

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