Clinical changes

Oedema and fibrinous exudate often lead to fibrosis of the subcutaneous tissues, which may be associated with localised loss of pigment and dilated capillary loops, an appearance known as "atrophic blanche". This occurs around the ankle with oedema and dilated tortuous superficial veins proximally and can lead to "champagne bottle legs", the bottle, of course, being inverted. Ulceration often occurs for the first time after a trivial injury.

Lymphoedema results from obliteration of the superficial lymphatics, with associated fibrosis. There is often hypertrophy of the overlying epidermis with a "polypoid" appearance, also known as lipodermatosclerosis.

Venous ulcers occur around the ankles, commonly over the medial malleolus. The margin is usually well defined with a shelving edge, and a slough may be present. There may also be surrounding eczematous changes. Venous ulcers are not usually painful but arterial ulcers are.

It is important to check the pulses in the leg and foot as compression bandaging of a leg with impaired blood flow can cause ischaemia and necrosis.

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