Leg Ulcers: Diagnosis and management PDF

Preface

In ancient times, treatment of leg ulcers was an important part of surgical practice.Witness the lasting contributions of Ambroise Paré. Even into the middle of the twentieth century, leg ulcers were an important part of surgical research and patient care.As modern vascular surgery dawned, important observations on causation of leg ulcer in Boston by Linton and in London by Cockett stirred surgical imagination. The subsequent introduction of safe, reliable anesthesia, safe blood transfusions, the development of antibiotics and the perfection of anticoagulation allowed surgeons to enter the no-man's land of arterial repair. Vascular operations were no longer restricted to varicose vein surgery, sympathectomy and amputation. Direct surgery of atherosclerosis, total excision of aneurysms with confidence in subsequent arterial reconstruction attracted a new generation of young and aggressive surgeons.

Interest in varicose veins languished just as belief in the powers of sympathectomy vanished. The heavy workload of arterial reconstructive surgery in an ever-aging population left vascular surgeons little time for the treatment of leg ulcers. Diagnosis became largely relegated to dermatologists and treatment to nurses.

Just as surgical interest in leg ulcers waned, new tools of patient investigation emerged. Physiological investigation developed beyond non-specific venous pressure determination to precise delineation of venous abnormalities in the ulcerated limb. Ultrasound imaging was introduced and has now largely replaced phlebography. Other imaging methods became available and the new instrumentation confirmed that leg ulcers were not exclusively in the province of the post-phlebitic limb but that many were caused by easily repairable superficial venous incompetence, as had been originally observed by John Homans of Boston in 1916.

Some surgical interest in venous abnormalities persisted during the last half of the twentieth century. At the turn of the century, the place of valve repair became defined more clearly, the limitations of the bypass principle became recognized, and the reopening of occluded venous segments using interventional radiological techniques showed promise. Investigations into the molecular biology of venous insufficiency and valve destruction and the causes of venous-related dermatitis, lipodermatosclerosis and skin breakdown hinted at pharmacological manipulation to ease the burdens of the chronic, intractable and recurrent venous ulcer.

As these many venous-related events transpired, this volume passed through infancy and adolescence marked by the first and second editions. Now, this third edition shows the promise of maturity, fortified with new information, new tools and the need for expert and efficient care.Many of the individuals who contributed to the last quarter century's advances in venous diagnosis and new methods of venous care of have now contributed to this new volume. The manifold advances in all aspects of venous investigations and patient care have demanded that this become a multi-authored text.

This book is therefore no longer ‘a practical guide to management' but a collection of expert contributions and the subtitle ‘diagnosis and management' seems more appropriate. A gratifying number of distinguished specialist authors, from many countries, accepted our invitation and have together created a work of which they can be proud.We are most grateful to each and to all of them.

Without the patience and efficiency of the staff of Hodder Arnold, it is doubtful if our task would have been completed and we are most grateful for their help.

The international authorship of this volume reflects the widespread growth of interest in the treatment of leg ulcers. This growth has been much helped by the Union Internationale de Phlébologie, whose conferences are increasingly well attended, and we are honored that Dr Georges Jantet, immediate past president, has provided the foreword.