Clinical Findings:

Right lower limb - entire polio limb with severe muscle wasting and shortening of limb scar on medial aspect of leg - of operation, with multiple secondary vericosities

Left lower limb - Large chronic non-healing ulcer lower 1/3 of leg just above medial meleolus with marked surounding cellulitis the ulcer is in the lower end of the operative scar and multiple secondaries.

Investigation reports

Venous angiography was done of Left lower extremity impressions of the investigation were.

Mr.M..... 29 yrs old has extensive and complete (100%) thrombotic obstruction of all the major veinsof left lower extremity - namely Tibial , Femoral , poplitial , and Iliac. This extensive obstruction has has produced severe chronic venous circulatory insufficiency of left lower limb resulting in chronic non-healing venous ulcer of left leg at Ankle, in the area of scar resulting after the operation of excision of left long saphenous vein.

As regards the treatment of this disease, the ulcer may tend to heal only if the venous circulation of the limb can be improved an attempt to partially improve the venous circulation can be made by performing the operation of crossover by pass grafting, by mobilising the colaterals right long saphenous vein and implanting it in the left lower limb. to achieve this, we shall have to first perform venous angiography of right lower extremity , and confirm that the venous circulation of right lower limb is adequate enough for it to spare its long saphenous vein for the contralateral left lower limb .

The second stage of this treatment - a few months after the above mentioned bypass grafting operation - will consist of skin grafting of the ulcer , encasing the limb in plaster of paris shell , and complete non-weight bearing on that limb untill the ukcer heals up completely .

This entire exercise is a stiff uphill task requiring full cooperation and dedication from the patient . There doesnot seem to be any other treatment as an alternative to this .

After having look at the case detail history and investigations following symptoms and signs were notted