60 yrs old mom has varicose veins since 20 yrs and now ulcers for 5 yrs on one leg. no diabetes and now laser surgery failed. please help.

Fail vein procedure: With ulcers for 5 years, and varicosities for 20 years your mom is advanced and likely has pretty high venous pressures. A failure of vein intervention is disappointing, however failures do occur with a certain frequency. At this point she needs compression stockings, wound care to get the ulcer healed, a repeat vein ultrasound and then a second vein intervention. Okay to ask for a second opinion.

Venous ulcer care: The mainstays of venous ulcer care are compression to counter the venous hypertension pressures. Proper wound care to make sure the environment of the ulcer is ideal for healing. Treatment of underlying venous reflux in superficial veins, both in the saphenous vein/s, which it sounds like has happened, and saphenous tributary veins that lead to the ulcer.Best results if all the bases are covered.

Meticulous vein care: I agree with drs. Berg and wright. Longstanding ulcers like this are difficult to treat but ulcer healing is very possible. The cause of the ulcer is venous hypertension and all potential sources for the venous hypertension must be addressed. All the while, effective compression to further reduce the venous pressures are essential. These ulcers can, and do, but it takes patinece and time.

Venous Hypertension: Venous ulcers are due to back up of venous blood due to leaking(refluxing) valves which in turn lead to venous hypertension, venous stasis in the ankles, weakened skin and finally ulceration. If laser failed, then the venous ultrasound needs to be repeated to try to find other sources feeding the ulcer such as perforators or ancillary veins. Compression hose and wound care is also essential.

See a vein specialis: Leg ulcers are often caused by chronic venous insufficiency which is a problem that causes to much pressure to be in the veins near the skin. Laser ablation is used to treat this condition. It is important to treat incompetent perforator veins which are very important in ulcer formation. A venous specialist can diagnose and treat this condition. Our cure rate with venous ulcers is 97%.

Multifactorial: Wounds need to be addressed in several ways. Some factors include: infection control, wound debridement, and compression therapy.