Q: My 60 years old mother is suffering from varicose vein. Two months back, her right leg got injured and she was treated for a week. Tetanus injection was also given but the wound has still not healed. She is not suffering from diabetes or blood pressure. She had taken antibiotic tablets but the wound’s condition remains unchanged? She is also having pain. How can her wound be treated?

A:The condition described is that of a venous ulcer, precipitated by trauma. As the patient has been suffering from Varicose Veins it is not uncommon occurrence. The clinical situation has to be treated as per following protocol. The immediate treatment of infection if any, as there is pain so the infection is likely. This can be achieved by taking a bacterial culture from the ulcer and given appropriate antibiotics. Also that she is having pain this will need pain relief and rest. The patient needs to take rest with limb in elevated position. Once the pain is better and infection is eliminated or significantly reduced she will need the status of venous and arterial circulation assessed. This can be done with Duplex scan (Doppler) of the veins and arteries.

Following this and assuming that arterial circulation is satisfactory, she will need compression along with the dressings. This is done by using 3or 4 layered compression bandage and dressings. During this period patient encouraged to walk. The frequency of the dressings will be determined by the amount of infection present. If the infection is less then less frequent dressings or vice versa. Once the ulcer is healed then long term management needs to be decided, i.e. if she needs surgical intervention or long term compression hosiery and weight reduction and life style change.