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Separation of gangrene A zone of demarcation between the truly viable and the dead or dying tissue will eventually appear. Separation is achieved by the development of a layer of granulation tissue, which forms between the dead and the living parts. In dry ...

Specific varieties of gangrene Diabetic gangrene Diabetic gangrene is usually caused by a combination of three factors: ischaemia secondary to macrovascular disease and microvascular dysfunction; peripheral sensorimotor neuropathy (PSN), which leads to trophic ...

Sympathectomy Endoscopic transthoracic sympathectomy is now reserved as a minimally invasive treatment of palmar and axillary hyperhidrosis. Open cervical sympathectomy was used in the past as a treatment of vasospastic disorders but was usually unsuccessful...

Treatment of gangrene How much of a limb or digit can be salvaged depends on the blood supply proximal to the gangrene. Poor circulation should be improved by surgical revascularisation, enabling a more conservative debridement or distal amputation. However, ...

disease The principles of arterial surgery outlined above can be applied at other arterial sites. Carotid stenosis (at the carotid bifurcation in the neck) may cause TIAs. These short-lived mini-strokes are often recurrent and cause unilateral motor or sensor...

AXILLARY VEIN THROMBOSIS Thrombosis of the axillary vein (Paget–Schrotter disease) may occur following excessive exercise in a patient with an anatomically abnormal thoracic outlet, but is also associated - with excessive muscle bulk as found in weight lifter...

Aetiology The three factors described by Virchow over a century ago are still relevant in the development of venous thrombosis. These are: /uni25CF contact of blood with an abnormal surface (e.g. endothelial damage); /uni25CF abnormal flow (e.g. stasis); /uni...

CLINICAL FEATURES OF VENOUS HYPERTENSION OF THE LEG The following clinical features are commonly seen: /uni25CF Varicose vein: subcutaneous dilated vein 3 /uni00A0 mm in diameter or larger. They are frequently elongated and tortuous, with intermittent ‘blowout...

CONGENITAL VENOUS ANOMALIES There are four main types of anomaly: /uni25CF aplasia; /uni25CF hypoplasia; /uni25CF duplication; /uni25CF persistence of vestigial vessels. Aplasia is most commonly seen in the inferior vena cava and has a similar presentation t...

Classification system The descriptive CEAP (Clinical–aEtiology–Anatomy–Patho physiology) classification for chronic venous disorders is widely utilised. - - Figure 62.6 Advanced skin changes: lipodermatosclerosis, eczema and atrophie blanche. Figure 62.7 Pigment...

Clinical features The ulcer must be carefully examined. A venous ulcer usually has a gently sloping edge and the floor contains granulation tissue covered by a variable amount of slough and exudate. Any significant elevation of the ulcer edge should indicate t...

Cystic degeneration As in the peripheral arterial system, cystic degeneration of the vein wall is an uncommon cause of venous occlusion. It may be detected by ultrasound. The cyst may be deroofed or the venous segment excised. -

Diagnosis The most common presentation of a DVT is pain and swelling, especially in the calf, usually in one leg; however, bilateral DVTs are common, occurring in up to 30%. When the swelling ) . - - Figure 62.31 An organised thrombus. is bilateral, DVT must ...

Epidemiology The adult prevalence of visible varicose veins is between 30% and 50%. Factors a ff ecting prevalence include: /uni25CF Gender: the vast majority of studies report a higher preva - lence in women than in men, though community preva - lence may di...

FURTHER READING Barwell JR, Davies CE, Deacon J et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet 2004; 1857–60. Brittenden J, Cotton SC, Elders A et al. Clinic...

INTRODUCTION Up to 40% of the adult population in resource-rich countries have diseases of the veins of the leg. This extraordinary prevalence along with the associated impairment in health- related quality of life make it a very important area of surgica...

Investigation Tourniquet tests and the use of hand-held Doppler have now been abandoned. There is good evidence to support the policy of duplex ultrasound scanning for all patients with varicose veins prior to any intervention. The best clinical results come...

Klippel–Trénaunay syndrome This is a combined anomaly of a cutaneous naevus, persistent vestigial veins with varicose veins and soft-tissue and bone hypertrophy . The condition is a mesodermal abnormality that is not familial ( Figure 62.36 ). Segments of th...