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Title: The management of gravitational ulcer
Author: Wright, Robert B.
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1952
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1. The magnitude of the problem of gravitational ulcer is indicated. 2. A brief historical review of treatment methods is presented. 3. The normal venous circulation of the lower limb is described and the conditions which may lead to venous stasis reviewed. 4. A scheme of management based on attempts to restore the disordered haemodynamics is described and the technical considerations discussed. 5. A practical method of locating incompetent communicating veins is described. 6. Methods designed to assess the state of efficiency of the deep veins are described: no clinical or venographic test is accurate enough for practical use. 7. A follow up study of cases of puerperal white leg is presented. 8. A scheme of treatment is outlined and the results of its application to a series of 284 consecutive cases of gravitational ulcer presented. 9. A discussion of the views of others on various aspects of the problem is presented and the following conclusions noted: (1) Gravitational ulcer does not result from the presence of varicose veins alone, a phlebitic factor is a necessary precursor. (2) Gravitational ulcer may occur in the absence of superficial varices. (3) Superficial varicose veins never represent a useful collateral circulation after deep thrombosis. Indeed, in the majority of cases the varices precede the deep thrombosis. The elimination of reflux into and stasis in such superficial varices is always beneficial to the total venous economy of the limb. (4) Continued elastic support is essential to reduce the risk of recurrence from the continuing effects of deep vein insufficiency. (5) Skin grafting directly on to muscle or periosteum is a useful procedure in resistant cases. 10. The procedure of deep vein ligation is discussed and five cases briefly presented.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available