Venous Ulcer in Chronic Venous insufficiency

Chronic venous disease is noted as large venous ulcers around the ankle. In India, it is not uncommon to see this type of advanced forms of chronic venous disease (see Fig.)
There are many reasons which make this type presentation a common feature in the govt general hospital out patient clinics. Some times the plastic surgeons attempt skin grafting for these ulcers after control of infection with regular dressing. But these ulcer recur due to the underlying venous insufficiency. Venous reflux in the superficial veins is addressed by Flush ligation of the SFJ, SPJ and perforators. But the deep venous insufficiency is left to subside or regress with the external compression therapies in the post operative period for few years. Very few hospitals are able to consider some form of therapy for the deep vein reflux across the globe and in India.