Indian Journal of Surgery

, Volume 80, Issue 2, pp 171–182 | Cite as

Evidence-Based Clinical Practice Points for the Management of Venous Ulcers

  • Ravul Jindal
  • D. B. Dekiwadia
  • Pinjala Rama Krishna
  • Ajay K. Khanna
  • Malay D. Patel
  • Shoaib Padaria
  • Roy Varghese
Review Article


Venous ulcer is an extremely common aetiology of lower extremity ulceration, which affects approximately 1% population in most of the countries, and the incidence rate increases with age and female gender. Proper assessment and diagnosis of both the patient and ulcer are inevitable in order to differentiate venous ulcers from other lower extremity ulceration and to frame an adequate and individualised management plan. Venous ulcers generally persist for weeks to many years and are typically recurrent in nature. This consensus aims to present an evidence-based management approach for the patients with venous ulcers. Various management options for venous ulcers include compression therapy, minimally invasive procedures like sclerotherapy and ablation techniques, surgical procedures, debridement and medical management with micronised purified flavonoid fraction (MPFF). Compression therapy is the mainstay treatment for venous ulcer. However, in failure cases, surgery can be preferred. Medical management with MPFF as an adjuvant therapy to standard treatment has been reported to be effective and safe in patients with venous ulcer. In addition to standard therapy, diet and lifestyle modification including progressive resistance exercise, patient education, leg elevation, weight reduction, maintaining a healthy cardiac status and strong psychosocial support reduces the risk of recurrence and improves the quality of life in patients with venous ulcer.


Venous ulcer Compression MPFF Surgical procedures Lifestyle modification 


Compliance with Ethical Standards

Conflict of Interests

All the authors declare that they have no conflict of interest.

Supplementary material

12262_2018_1726_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 28 kb)


  1. 1.
    Collins L, Seraj S (2010) Diagnosis and treatment of venous ulcers. Am Fam Physician 81(8):989–996PubMedGoogle Scholar
  2. 2.
    O'Donnell TF, Passman MA (2014) Clinical practice guidelines of the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF)—management of venous leg ulcers. Introduction J Vasc Surg 60(2 Suppl):1S–2S. PubMedGoogle Scholar
  3. 3.
    Agale SV (2013) Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers 2013:1–9. CrossRefGoogle Scholar
  4. 4.
    Nelzen O (2008) Prevalence of venous leg ulcer: the importance of the data collection method. Phlebolymphology 15(4):143–150Google Scholar
  5. 5.
    Pinjala RK, Abraham TK, Chadha SK, Hai AA, Hussain SA, Moulik AK, Nagori LF, Nayak G, Patel MD, Sen G, Shetty SV, Sinha KN (2004) Long-term treatment of chronic venous insufficiency of the leg with micronized purified flavonoid fraction in the primary care setting of India. Phlebology 19(4):179–184. CrossRefGoogle Scholar
  6. 6.
    Dekiwadia DB, Jindal R, Varghese R, Bedi HS, Padaria S, Patel MD, Agarwal S, Saravanan S, Rao UV, Pinjala R, Singh G (2016) Executive summary: a consensus statement—part I: recommendations for the management of chronic venous disease (CVD) in India and key role of primary care doctors. J Assoc Physicians India 64(8):53–56PubMedGoogle Scholar
  7. 7.
    Prakash S, Tiwary SK, Mishra M, Khanna AK (2013) Venous ulcer. Surg Sci 4(2):144–150. CrossRefGoogle Scholar
  8. 8.
    Ramamoorthy P (2013) The growing threat of chronic venous disease. Medicine update Jaypee Brothers Medical Publishers Pvt Ltd:753–756Google Scholar
  9. 9.
    Langer V (2014) Leg ulcers: an Indian perspective. Indian Dermatol Online J 5(4):535–536. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Vishwanath V (2014) Venous leg ulcer: management aspect in Indian scenario. Indian Dermatol Online J 5(3):396. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wittens CD, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S et al (2015) Editor's choice—management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 49(6):678–737. CrossRefPubMedGoogle Scholar
  12. 12.
    Angel D, Barker J, Blanchfield D, Carville K, Haesler E, Hillier S et al (2011) Australian and New Zealand clinical practice guideline for prevention and management of venous leg ulcers 2011Google Scholar
  13. 13.
    Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, Meissner MH, Moneta GL, Myers K, Padberg FT, Perrin M, Ruckley CV, Smith PC, Wakefield TW, American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification et al (2004) Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 40(6):1248–1252. CrossRefPubMedGoogle Scholar
  14. 14.
    Zenilman J, Valle MF, Malas MB, Maruthur N, Qazi U, Suh Y et al (2013) Chronic venous ulcers: a comparative effectiveness review of treatment modalities [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US). Available from
  15. 15.
    Franks PJ, Barker J, Collier M, Gethin G, Haesler E, Jawien A, Laeuchli S, Mosti G, Probst S, Weller C (2016) Management of patients with venous leg ulcers: challenges and current best practice. J Wound Care 25(Sup6):S1–S67. CrossRefPubMedGoogle Scholar
  16. 16.
    Shenoy MM (2014) Prevention of venous leg ulcer recurrence. Indian Dermatol Online J 5(3):386–389. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dogra S, Sarangal R (2014) Summary of recommendations for leg ulcers. Indian Dermatol Online J 5(3):400–407. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Rai R (2014) Standard guidelines for management of venous leg ulcer. Indian Dermatol Online J 5(3):408–411. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Milic DJ, Zivic SS, Bogdanovic DC, Karanovic ND, Golubovic ZV (2009) Risk factors related to the failure of venous leg ulcers to heal with compression treatment. J Vasc Surg 49(5):1242–1247CrossRefPubMedGoogle Scholar
  20. 20.
    White-Chu EF, Conner-Kerr TA (2014) Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective. J Multidiscip Healthc 7:111–117. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lazareth I, Hubert S, Michon-Pasturel U, Priollet P (2007) Vitamin C deficiency and leg ulcers. A case control study. J Mal Vasc 32(2):96–99. CrossRefPubMedGoogle Scholar
  22. 22.
    Burkievcz CJ, Skare TL, Malafaia O, Nassif PA, Ribas CS, Santos LR (2012) Vitamin D deficiency in patients with chronic venous ulcers. Rev Col Bras Cir 39(1):60–63. CrossRefPubMedGoogle Scholar
  23. 23.
    Yang D, Vandongen YK, Stacey MC (1999) Effect of exercise on calf muscle pump function in patients with chronic venous disease. Br J Surg 86(3):338–341CrossRefPubMedGoogle Scholar
  24. 24.
    Kan YM, Delis KT (2001) Hemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration: a prospective controlled study. Arch Surg 136(12):1364–1369. CrossRefPubMedGoogle Scholar
  25. 25.
    O'Brien J, Edwards H, Stewart I, Gibbs H (2013) A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study. Int Wound J 10(4):389–396. CrossRefPubMedGoogle Scholar
  26. 26.
    Finlayson K, Edwards H, Courtney M (2011) Relationships between preventive activities, psychosocial factors and recurrence of venous leg ulcers: a prospective study. J Adv Nurs 67(10):2180–2190CrossRefPubMedGoogle Scholar
  27. 27.
    Abu-Own A, Scurr JH, Smith PD (1994) Effect of leg elevation on the skin microcirculation in chronic venous insufficiency. J Vasc Surg 20(5):705–710. CrossRefPubMedGoogle Scholar
  28. 28.
    (2010) Management of chronic venous leg ulcers. A national clinical guideline. SIGN PublicationGoogle Scholar
  29. 29.
    Nicolaides A, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P et al (2014) Management of chronic venous disorders of the lower limbs—guidelines according to scientific evidence. Int Angiol 33(2):87–208PubMedGoogle Scholar
  30. 30.
    Scallon C, Bell-Syer SE, Aziz Z (2013) Flavonoids for treating venous leg ulcers. Cochrane Database Syst Rev 5:CD006477Google Scholar
  31. 31.
    Coleridge-Smith P, Lok C, Ramelet AA (2005) Venous leg ulcer: a meta-analysis of adjunctive therapy with micronized purified flavonoid fraction. Eur J Vasc Endovasc Surg 30(2):198–208CrossRefPubMedGoogle Scholar
  32. 32.
    Bush R, Comerota A, Meissner M, Raffetto JD, Hahn SR, Freeman K (2017) Recommendations for the medical management of chronic venous disease: the role of micronized purified flavanoid fraction (MPFF) recommendations from the Working Group in Chronic Venous Disease (CVD) 2016. Phlebology 32(1_suppl):3–19CrossRefPubMedGoogle Scholar
  33. 33.
    Maggioli A (2016) Chronic venous disorders: pharmacological and clinical aspects of micronized purified flavonoid fraction. Phlebolymphology 23(2):82–91Google Scholar
  34. 34.
    Cospite M, Dominici A (1988) Double blind study of the pharmacodynamic and clinical activities of 5682 SE in venous insufficiency. Advantages of the new micronized form. Int Angiol 8(4 Suppl):61–65Google Scholar
  35. 35.
    Amato C (1994) Advantage of a micronized flavonoidic fraction in comparison with a nonmicronized diosmin. Angiology 45(6 Pt 2):531–536. CrossRefPubMedGoogle Scholar
  36. 36.
    Leach MJ, Pincombe J, Foster GW (2006) Clinical efficacy of horse chestnut seed extract in the treatment of venous ulceration. J Wound Care 15(4):159–167CrossRefPubMedGoogle Scholar
  37. 37.
    Stegmann W, Hubner K, Deichmann B, Muller B (1987) Efficacy of O-(beta-hydroxyethyl)-rutosides in the treatment of venous leg ulcers. Phlebologie 40(1):149–156PubMedGoogle Scholar
  38. 38.
    Wright DD, Franks PJ, Blair SD, Backhouse CM, Moffatt C, McCollum CN (1991) Oxerutins in the prevention of recurrence in chronic venous ulceration: randomized controlled trial. Br J Surg 78(10):1269–1270. CrossRefPubMedGoogle Scholar
  39. 39.
    Martinez-Zapata MJ, Moreno RM, Gich I, Urrútia G, Bonfill X (2008) A randomized, double-blind multicentre clinical trial comparing the efficacy of calcium dobesilate with placebo in the treatment of chronic venous disease. Eur J Vasc Endovasc Surg 35(3):358–365. CrossRefPubMedGoogle Scholar
  40. 40.
    Ibáñez L, Ballarín E, Vidal X, Laporte JR (2000) Agranulocytosis associated with calcium dobesilate. Eur J Clin Pharmacol 56(9):763–767. CrossRefPubMedGoogle Scholar
  41. 41.
    Zapater P, Horga JF, García A (2003) Risk of drug-induced agranulocytosis: the case of calcium dobesilate. Eur J Clin Pharmacol 58(11):767–772. CrossRefPubMedGoogle Scholar
  42. 42.
    Dale JJ, Ruckley CV, Harper DR, Gibson B, Nelson EA, Prescott RJ (1999) Randomised, double blind placebo controlled trial of pentoxifylline in the treatment of venous leg ulcers. BMJ 319(7214):875–878. CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Nelson EA, Prescott RJ, Harper DR, Gibson B, Brown D, Ruckley CV (2007) A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers. J Vasc Surg 45(1):134–141. CrossRefPubMedGoogle Scholar
  44. 44.
    Jull AB, Arroll B, Parag V, Waters J (2012) Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev 12:CD001733PubMedGoogle Scholar
  45. 45.
    Layton AM, Goodfield MJ, Ibbotson S, Davies JA (1994) Randomised trial of oral aspirin for chronic venous leg ulcers. Lancet 344(8916):164–165. CrossRefPubMedGoogle Scholar
  46. 46.
    del Río Solá ML, Antonio J, Fajardo G, Puerta CV (2012) Influence of aspirin therapy in the ulcer associated with chronic venous insufficiency. Ann Vasc Surg 26(5):620–629. CrossRefPubMedGoogle Scholar
  47. 47.
    de Oliveira Carvalho PE, Magolbo NG, De Aquino RF, Weller CD (2016) Oral aspirin for treating venous leg ulcers. Cochrane Database Syst Rev 2:CD009432PubMedGoogle Scholar
  48. 48.
    Jull A, Wadham A, Bullen C, Parag V, Kerse N, Waters J (2016) Low-dose aspirin as an adjuvant treatment for venous leg ulceration: study protocol for a randomized controlled trial (Aspirin4VLU). J Adv Nurs 72(3):669–679. CrossRefPubMedGoogle Scholar
  49. 49.
    Tilbrook H, Forsythe RO, Rolfe D, Clark L, Bland M, Buckley H et al (2015) Aspirin for Venous Ulcers: Randomised Trial (AVURT): study protocol for a randomised controlled trial. Trials 6(1):513CrossRefGoogle Scholar
  50. 50.
    Raposio E, Libondi G, Bertozzi N, Grignaffini E, Grieco MP (2015) Effects of topic simvastatin for the treatment of chronic vascular cutaneous ulcers: a pilot study. J Am Coll Clin Wound Spec 7(1–3):13–18. CrossRefPubMedGoogle Scholar
  51. 51.
    Evangelista MT, Casintahan MF, Villafuerte LL (2014) Simvastatin as a novel therapeutic agent for venous ulcers: a randomized, double-blind, placebo-controlled trial. Br J Dermatol 170(5):1151–1157. CrossRefPubMedGoogle Scholar
  52. 52.
    O'Meara S, Al-Kurdi D, Ologun Y, Ovington LG, Martyn-St James M, Richardson R (2014) Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev (1):CD003557Google Scholar
  53. 53.
    Amato B, Coretti G, Compagna R, Amato M, Buffone G, Gigliotti D (2015) Role of matrix metalloproteinases in non-healing venous ulcers. Int Wound J 12(6):641–645. CrossRefPubMedGoogle Scholar
  54. 54.
    Guilhou JJ, Dereure O, Marzin L, Ouvry P, Zuccarelli F, Debure C, van Landuyt H, Gillet-Terver MN, Guillot B, Levesque H, Mignot J, Pillion G, Février B, Dubeaux D (1997) Efficacy of MPFF in venous leg ulcer healing: a double-blind, randomised, controlled versus placebo trial in 107 patients. Angiology 48(1):77–85. CrossRefPubMedGoogle Scholar
  55. 55.
    Glinski W, Chodynicka B, Roszkiewicz J, Bogdanowski T, Lecewicz-Torun B, Kaszuba A et al (1999) The beneficial augmentative effect of micronised purified flavonoid fraction (MPFF) on the healing of leg ulcers: an open, multicentre, controlled, randomised study. Phlebology 14(4):151–157. CrossRefGoogle Scholar
  56. 56.
    Roztocil K, Stvrtinová V, Strejcek J (2003) Efficacy of a 6-month treatment with MPFF in patients with venous leg ulcers associated with chronic venous insufficiency. Int Angiol 22(1):24–31PubMedGoogle Scholar
  57. 57.
    Dogra S, Rai R (2014) Venous leg ulcer: topical treatment, dressings and surgical debridement. Indian Dermatol Online J 5(3):371–973. CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Palfreyman S, Nelson EA, Michaels JA (2007) Dressings for venous leg ulcers: systematic review and meta-analysis. BMJ 335(7613):244. CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Jiburum BC, Opara KO, Nwagbara IC (2011) Experience with vacuum-assisted closure device in the management of benign chronic leg ulcers. J West Afr Coll Surg 1(1):89–100PubMedPubMedCentralGoogle Scholar
  60. 60.
    Leclercq A, Labeille B, Perrot JL, Vercherin P, Cambazard F (2016) Skin graft secured by VAC (vacuum-assisted closure) therapy in chronic leg ulcers: a controlled randomized study. Ann Dermatol Venereol 143(1):3–8CrossRefPubMedGoogle Scholar
  61. 61.
    Körber A, Franckson T, Grabbe S, Dissemond J (2008) Vacuum assisted closure device improves the take of mesh grafts in chronic leg ulcer patients. Dermatology 216(3):250–256. CrossRefPubMedGoogle Scholar
  62. 62.
    Carter MJ, Tingley-Kelley K, Warriner RA (2010) Silver treatments and silver-impregnated dressings for the healing of leg wounds and ulcers: a systematic review and meta-analysis. J Am Acad Dermatol 63(4):668–679CrossRefPubMedGoogle Scholar
  63. 63.
    Jull A, Walker N, Parag V, Molan P, Rodgers A (2008) Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg 95(2):175–182CrossRefPubMedGoogle Scholar
  64. 64.
    Westby MJ, Norman G, Dumville JC, Stubbs N, Cullum N (2016) Protease-modulating matrix treatments for healing venous leg ulcers. Cochrane Database Syst Rev 12:CD011918PubMedGoogle Scholar
  65. 65.
    O'Meara S, Martyn-St James M, Adderley UJ (2015) Alginate dressings for venous leg ulcers. Cochrane Database Syst Rev 8:CD010182Google Scholar
  66. 66.
    Mauck KF, Asi N, Elraiyah TA, Undavalli C, Nabhan M, Altayar O et al (2014) Comparative systematic review and meta-analysis of compression modalities for the promotion of venous ulcer healing and reducing ulcer recurrence J Vasc Surg 60(2):71S–90S. e1–2Google Scholar
  67. 67.
    Ratliff CR, Yates S, McNichol L, Gray M (2016) Compression for primary prevention, treatment, and prevention of recurrence of venous leg ulcers: an evidence-and consensus-based algorithm for care across the continuum. J Wound Ostomy Continence Nurs 43(4):347–364. CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Nair B (2014) Compression therapy for venous leg ulcers. Indian Dermatol Online J 5(3):378–382. CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Ashby RL, Gabe R, Ali S, Saramago P, Chuang LH, Adderley U, Bland JM, Cullum NA, Dumville JC, Iglesias CP, Kang’ombe AR, Soares MO, Stubbs NC, Torgerson DJ (2014) VenUS IV (Venous Leg Ulcer Study IV)—compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomised controlled trial, mixed-treatment comparison and decision-analytic model. Health Technol Assess 18(57):1–293, v-vi. CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Finlayson KJ, Courtney MD, Gibb MA, O'Brien JA, Parker CN, Edwards HE (2014) The effectiveness of a four-layer compression bandage system in comparison with Class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomised controlled trial. Int Wound J 11(1):21–27. CrossRefPubMedGoogle Scholar
  71. 71.
    Lazareth I, Moffatt C, Dissemond J, Lesne Padieu AS, Truchetet F, Beissert S et al (2012). Efficacy of two compression systems in the management of VLUs: results of a European RCT. J Wound Care. 21(11):553-4, 556, 558 passimGoogle Scholar
  72. 72.
    Szewczyk MT, Jawień A, Cierzniakowska K, Cwajda-Białasik J, Mościcka P (2010) Comparison of the effectiveness of compression stockings and layer compression systems in venous ulceration treatment. Arch Med Sci 6(5):793–799CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Kapp S, Miller C, Donohue L (2013) The clinical effectiveness of two compression stocking treatments on venous leg ulcer recurrence: a randomized controlled trial. Int J Low Extrem Wounds 12(3):189–198CrossRefPubMedGoogle Scholar
  74. 74.
    Harper DR, Ruckley CV, Gibson B, Brown D, Prescott RJ (1999) Randomised trial of two grades of compression stockings in the prevention of venous ulcer recurrence—5 year outcomes. Phlebology 14(91)Google Scholar
  75. 75.
    Wong IK, Andriessen A, Charles HE, Thompson D, Lee DT, So WK et al (2012) Randomized controlled trial comparing treatment outcome of two compression bandaging systems and standard care without compression in patients with venous leg ulcers. J Eur Acad Dermatol Venereol 26(1):102–110. CrossRefPubMedGoogle Scholar
  76. 76.
    Harrison MB, VanDenKerkhof EG, Hopman WM, Graham ID, Carley ME, Nelson EA (2011) The Canadian Bandaging Trial: evidence-informed leg ulcer care and the effectiveness of two compression technologies. BMC Nurs 10(1):20. CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    O'Meara S, Cullum N, Nelson EA, Dumville JC (2012) Compression for venous leg ulcers. Cochrane Database Syst Rev 11:CD000265PubMedGoogle Scholar
  78. 78.
    Vanscheidt W, Ukat A, Partsch H (2009) Dose-response of compression therapy for chronic venous edema—higher pressures are associated with greater volume reduction: two randomized clinical studies. J Vasc Surg 49(2):395–402CrossRefPubMedGoogle Scholar
  79. 79.
    Harlander-Locke M, Lawrence PF, Alktaifi A, Jimenez JC, Rigberg D, DeRubertis B (2012) The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates. J Vasc Surg 55(2):458–464. CrossRefPubMedGoogle Scholar
  80. 80.
    Harlander-Locke M, Lawrence P, Jimenez JC, Rigberg D, DeRubertis B, Gelabert H (2012) Combined treatment with compression therapy and ablation of incompetent superficial and perforating veins reduces ulcer recurrence in patients with CEAP 5 venous disease. J Vasc Surg 55(2):446–450. CrossRefPubMedGoogle Scholar
  81. 81.
    Darvall KA, Bate GR, Adam DJ, Silverman SH, Bradbury AW (2009) Ultrasound-guided foam sclerotherapy for the treatment of chronic venous ulceration: a preliminary study. Eur J Vasc Endovasc Surg 38(6):764–769. CrossRefPubMedGoogle Scholar
  82. 82.
    Alden PB, Lips EM, Zimmerman KP, Garberich RF, Rizvi AZ, Tretinyak AS, Alexander JQ, Dorr KM, Hutchinson M, Isakson SL (2013) Chronic venous ulcer: minimally invasive treatment of superficial axial and perforator vein reflux speeds healing and reduces recurrence. Ann Vasc Surg 27(1):75–83. CrossRefPubMedGoogle Scholar
  83. 83.
    Samuel N, Carradice D, Wallace T, Smith GE, Chetter IC. Endovenous thermal ablation for healing venous ulcers and preventing recurrence. Cochrane Database Syst Rev (10):CD009494Google Scholar
  84. 84.
    Kulkarni SR, Slim FJ, Emerson LG, Davies C, Bulbulia RA, Whyman MR et al (2013) Effect of foam sclerotherapy on healing and long-term recurrence in chronic venous leg ulcers. Phlebology 28(3):140–146. CrossRefPubMedGoogle Scholar
  85. 85.
    Grover G, Tanase A, Elstone A, Ashley S (2016) Chronic venous leg ulcers: effects of foam sclerotherapy on healing and recurrence. Phlebology 31(1):34–41. CrossRefPubMedGoogle Scholar
  86. 86.
    Van Gent WB, Catarinella FS, Lam YL, Nieman FH, Toonder IM, van der Ham AC et al (2015) Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial. Phlebology 30(1_suppl):35–41. CrossRefPubMedGoogle Scholar
  87. 87.
    Howard DP, Howard A, Kothari A, Wales L, Guest M, Davies AH (2008) The role of superficial venous surgery in the management of venous ulcers: a systematic review. Eur J Vasc Endovasc Surg 36(4):458–465. CrossRefPubMedGoogle Scholar
  88. 88.
    Wright DD (2009) The ESCHAR trial: should it change practice? Perspect Vasc Surg Endovasc Ther 21(2):69–72. CrossRefPubMedGoogle Scholar
  89. 89.
    Nelson EA, Bell-Syer SE (2014) Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev 9:CD002303Google Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  • Ravul Jindal
    • 1
  • D. B. Dekiwadia
    • 2
  • Pinjala Rama Krishna
    • 3
  • Ajay K. Khanna
    • 4
  • Malay D. Patel
    • 5
  • Shoaib Padaria
    • 6
  • Roy Varghese
    • 7
  1. 1.Fortis HospitalMohaliIndia
  2. 2.Dekiwadia HospitalRajkotIndia
  3. 3.NIZAMS Institute of Medical SciencesHyderabadIndia
  4. 4.Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia
  5. 5.Apollo HospitalAhmedabadIndia
  6. 6.Jaslok Hospital, Breach Candy Hospital, Sir H.N. Hospital, Saifee HospitalMumbaiIndia
  7. 7.Daya HospitalJubilee Mission Medical CollegeTrichurIndia

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