Venous Ulcers Associated with Deep Venous Insufficiency
A 46-year-old female schoolteacher and non-smoker presented with an ulcer on the medial side of the ankle. The ulcer had persisted for the past year despite compressive dressings at a hospital wound care center. Ulcers in the same general area had occurred intermittently in the past but had healed with local wound care and dressings. The ulcer was very painful, particularly with dependency of the leg (7/10 over a visual analogue scale) and frequently at night. The patient had made a habit of elevating her legs during the day whenever feasible, and to sleep with her legs elevated on a pillow at night. She had been using a nonsteroidal anti-inflammatory drug once or twice a day at work for pain relief, but lately a narcotic prescribed by her physician was required for sleep at night. Even so, on some nights, she had to “walk off” the pain for 20–30 min before she could fall asleep.
Past medical history: She had been hospitalized on two occasions during the past year for...
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