A Case Series on an Innovative Multimodal Approach for the Management of Venous Ulcers: Endovenous Laser Ablation, Four-Layer Compression Therapy, and Medicinal Leech Therapy

Abstract

Venousulcersareoftenrecurrent,andopenulceration can last from weeks to years. Chronic venous disease (CVD) is a condition characterized by abnormal venous function and structure, often leading to symptoms and complications. Venous ulcers, the most severe manifestation of CVD, are open sores on the legs caused by chronic venous insufficiency (CVI) and venous hypertension, leading to inflammation, microcirculatory dysfunction, and impaired wound healing. This study evaluates the effectiveness of Endovenous Laser Therapy (EVLT), 4-layer bandaging (4-LB), and leech therapy (MLT) in promoting venous ulcer healing and reducing recurrence. 20 patients with lower limb venous ulcers underwent comprehensive clinical examination, laboratory investigations, and treatment combining these modalities. EVLT involved laser ablation of the great saphenous vein, complemented by foam sclerotherapy. The 4-layer bandage technique provided graduated compression to enhance venous return and manage oedema. Leech therapy, inspired by Ayurvedic principles, utilized bioactive compounds in leech saliva to promote anticoagulation, vasodilation, and anti-inflammatory effects, supporting wound healing.Results demonstrated significant clinical improvement, with 95% of patients achieving complete ulcer healing. Pre-treatment symptoms, assessed via the Venous Clinical Severity Score (VCSS), showed marked reduction in pain, edema, pigmentation, inflammation, induration, ulcer size, and duration post-treatment.This study highlights the synergistic potential of combining modern and traditional therapies, offering a promising, integrative approach to managing chronic venous ulcers. Further research with larger sample sizes and longer follow-up is warranted to validate these findings and optimize treatment protocols..