Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
Varicose veins are unnatural, irregular, and permanently dilated veins
which elongate and pursue a tortuous course. This condition is very
common, and twenty per cent. of adults exhibit it in some degree in
one region or another.
The causes of varicose veins are obstruction to venous return, and
weakness of cardiac action, which lessens the propulsion of the blood
stream.
Varicose veins may occur in any portion of the body, but are chiefly
met with on the inner side of the lower extremity.
Varix in the leg is met with during and after pregnancy, and in
persons who stand upon their feet for long periods.
It especially appears in the long saphenous vein, which, being
subcutaneous, has no muscular aid in supporting the blood-column and
in urging it on. The deep as well as the superficial veins may become
varicose.
Varicose veins are in rare instances congenital; they are most often
seen in the aged, but usually begin at the ages of twenty to forty.
A vein, under pressure, usually dilates more at one spot than at
another, the distention being greatest back of a valve or near the
mouth of a tributary. The valves become incompetent and the dilatation
becomes still greater. The vein wall may become fibrous, but usually
it is thin, and ruptures. The veins not only dilate, but they also
become longer, and hence do not remain straight but twist and turn
into a characteristic form.
Varicose veins are apt to cause edema, and the watery elements in the
tissues cause eczema of the skin. When eczema is once inaugurated,
excoriation is to be expected. Infection of the excoriated area
produces inflammation, suppuration, and an ulcer.
The skin over varicose veins in the legs is often discolored by
pigmentation due to the red cells having escaped from the vessel and
then being broken up.
The tissues around a varicose vein become atrophied from pressure, and
often a very large vein will be in evidence whose thin walls are in
close contact with the skin, and in this condition, rupture and
hemorrhage are probable. Varicose veins are apt to inflame and
thrombosis frequently occurs.
+Treatment.+ The treatment of varix may be palliative or curative, but
whichever is followed, endeavor first to remove the cause.
In palliative treatment, attend to the general health, keep up the
force and activity of the circulation, and prevent constipation.
Recommend the patient to exercise in the open air and to lie down, if
possible, every afternoon. Locally, in varix of the leg, order a
flannel bandage to support the vein and drive the blood into the
deeper vessels which have muscular support. (For technic, see chapter
on bandaging).
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