Stasis Ulcer after long history of blood clots

[SKD1869]

I'm not sure if this is a DVT question but it was a DVT that caused the problem I need help with. I have been dealing with a stasis ulcer on my right ankle for years now. It heals up for a time then breaks open again and it is very painful. I have tried everything from just staying off it to wound care specialists. I normally get it to heal with promogan prisma & Silver alginate but not this time. I wear compression hose to help with blood flow when the ulcer allows. Currently I am having trouble getting it to close up. I have been unable to work for weeks now and need to get back ASAP So if anyone out there has any ideas on how to get this thing to heal I would be grateful. Here is my background (the short version)    
I am a 44 yr old male diagnosed with a blood clotting disorder & sever venous insufficiency. They know it is genetic though all the genetic markers came back negative. I am the 6th person on my mothers side to have problems with DVTs.  In 2004 I had blot clots the complete length of both legs. The clots did a lot of damage to both legs but my right leg took the brunt of the damage. Both legs are swollen all the time and the veins well they look like garden hoses running under the skin. I have been to 3 Vascular surgeons and they are all afraid to try surgery. So I feel stuck with a leg that barley works and again I would be very grateful for any suggestions.

[bjammmin]

I use sayntl 250 unit ointment,use mepilex with safetac technology,not the border .just the self adverse foam pad.ive found that sticks the least out of everything I've ever tried.ill put a couple guaze pads over the foam.then rap from bottom of foot to bottom of knee.i usually rap the sports rap with 3m tape too.after I stop working v.s ulcer is usually closed up within 2weeks.hope this helps u

[SKD1869]

Thank you for your answer. I have gone to a # of vascular surgeons and they all are afraid to do any type of surgery on my leg. Due to the venous insufficiency. It was cause by the damage done to the valves in my leg. They all do not open like they should and leak blood into the tissue. Basically my right leg is black from the knee down. I was a very active person prior to the clots & still try to stay as active as I can. I have a 16 yr old son I have been teaching to archery hunt since he was very young. I enjoy being with him in the outdoors but the pain makes it very difficult.
Thanks again for your answer.
Sincerely Tony R.    

[S. Kaul, MD]

Hi there!

Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation. Ulcers developing secondary to venous stasis would require treatment of the primary cause/ venous insufficiency, aside measures that would promote ulcer healing. There are a few interventional options developed lately that may be considered alternative to surgery, if it is not advisable. I would suggest considering a detailed evaluation by a vascular surgeon, preferably at a university/ teaching hospital for suggestion of an appropriate management plan.
Hope this is helpful.

Take care!