Intractable postphlebitic ulceration of the leg

A new regimen for the successful treatment of intractable postphlebitic ulceration of the leg is described. It is based on preliminary culture of organisms in the ulcers followed by sensitivity tests to ascertain the appropriate antibiotics or antibacterials to be used. Patients with Pseudomonas infection are hospitalized and receive: intramuscular injections of amikacin sulphate 500 mg twice daily for 7 days; a once-daily spraying of antibiotic powder on the ulcer for 7 days; and a topical gentian violet regimen once daily for a further 2 days to encourage adhesion of a dressing to the ulcer bed. After discharge the patients are treated in the consulting rooms. Ulcers without Pseudomonas infection but from which organisms have been cultured are treated in the consulting rooms with drugs indicated by the results of sensitivity tests, and topical gentian violet. Patients from whom organisms have not been cultured are treated with co-trimoxazole and topical gentian violet. Patients are taught correct bandaging of the calf with a 150 mm wide crêpe bandage and a Rowden Foote elastic bandage. Firm bandaging prevents calf oedema, the factor predisposing to ulceration. Patients are initially seen daily and then, as the dressing becomes adherent, at decreasing intervals until it is shed. Both bandages are worn until the affected tissues heal. The patient is then fitted with a below-knee heavy-duty elastic stocking.