可疑的足部傷口

八十多歲的王伯，數年前因下肢靜脈曲張來求診，考慮到病人年紀不輕，病情不太嚴重，建議可暫作觀察，但同時叮嚀他和家人要多留意雙足情況，若有任何可疑病徵或惡化，應及早覆診。

數年過去，王伯最近再次由家人陪同回來，但行動開始不便，須以輪椅輔助，而足部問題亦明顯嚴重多了︰他的足部皮膚布滿啞色傷口、水泡，並非常痕癢。經檢查後，發現他的靜脈曲張病情已進入皮膚濕疹及慢性潰瘍的後期階段。

為 使情況盡快改善，王伯及其家人已主動要求安排手術治療。雖然王伯已年屆八十，但身體狀況並不太差，以微創方案進行手術還是可行的。但因病情嚴重，已出現潰 瘍，加上王伯行動不便，手術後的護理，如清潔傷口、包紮等，是很花工夫。本來計劃把王伯留院觀察數天，跟進其足部傷口，怎知他說在醫院睡得不好，堅持回 家。那洗傷口的責任就要交給家人了，對家人來說也非常擔心呢！

約八至九成原因不明的足部傷口，都是與血管問題有關。因此，本身有各種風險因素的人士，更應特別留意足部皮膚狀況，若出現腿部血管腫脹、下肢靜脈浮凸、足踝皮膚變色，以至足部皮膚長期痕癢及傷口等，為自己及家人，都不應掉以輕心。

作者為外科專科醫生

謝卓華

資料來源: AM730
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向醫生查詢，而不應單倚賴以上提供的資料。

上樓梯，小腿痛

除欣賞最愛的英超聯賽外，五十多歲的張先生亦喜歡落場踢球，熱情從少年時代至今從沒間斷，但隨著年紀漸長，過往在球場埋身肉搏的場面已不復見，在有限體力 下，只能間中與好友相約「踢衛生波」；本身既是煙民、又有高血壓問題的他，最近發覺自己在跑動時，雙腿很快便感無力，不禁自問︰「難道身體已經老化到這個 地步了嗎？」不過，事實似乎不是這樣。

後來張先生更發覺上樓梯時小腿很快便無力，在家人勸說下才肯求診，經血管外科醫生診斷後，發現他兩邊大腿中段的動脈血管，出現收窄現象，相信與其多年的吸煙習慣及高血壓問題、導致血管提早老化有關。

這類個案屬典型的「間歇性跛行」，有幸地張先生的情況並不算太嚴重，只在運動或上落樓梯時，才因下肢動脈供血不足而感到不適，暫時並無危險。但他覺得不能 在球場上奔馳是很大的損失，選擇接受微創血管手術，以「血管成型術」的方式將其收窄的大腿動脈血管撐開，改善血液流量，令其雙腿無力的情況得到紓緩。

然而，在本港不少此類疾病的患者對於手術始終存有一定抗拒， 相比起西方國家，患者普遍較著重自己的活動能力，通常都選擇及早接受治療，令生活質素得到維持。

外科專科醫生謝卓華

資料來源: AM730
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向醫生查詢，而不應單倚賴以上提供的資料。

Foam Sclerotherapy

1. What is Foam Sclerotherapy?

Foam Sclerotherapy is a effective way to treat spider and varicose veins. During this treatment, the medication (sclerosant) is mixed with air to form a suspension of micro-bubbles. The resulting foam is injected into the affected vein either directly or under ultrasound guidance. Because foam has a greater surface area than liquid, it is able to stick to the vein walls more effectively and cause faster ‘shrinkage’ of the damaged veins. Foam Sclerotherapy is more effective than conventional sclerotherapy, especially for larger veins.



2. How is foam sclerotherapy performed?

This is a simple procedure and does not require any anaesthesia. A needle is inserted into the main affected superficial vein, usually under ultrasound guidance. Sclerosant foam is then injected and monitored using ultrasound. The foam causes inflammation of the vein wall and obliteration of the vein. Further injections may be given during the same or different sessions to make sure that all the varicose veins



3. What are the advantages of Foam Sclerotherapy?

Sclerotherapy is very effective with bigger spider veins and small varicose veins. It is also a treatment of choice for varicose veins that remain or recur after surgery and those cannot be treated with other methods. Our team of specialists can advise you on treatment options after a detailed examination.




Reference information:  http://veno.com.hk/sclerotherapy-varicose-vein.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment. 

RadioFrequency Ablation (RFA) (2)

4. How soon after RFA can I return to normal activity?

Walking immediately following the procedure is encouraged and normal daily activity can be resumed immediately. For those into sports and heavy lifting, a delay of 5-7 days is recommended.


5. What are the key benefits of RFA?

RFA can be performed entirely under local anaesthesia in most cases. It is applicable to the majority of patients including those with pre-existing medical conditions or medications preventing the administration of a general anaesthetic. Cosmetic outcomes from RFA are far superior to stripping. Patients report minimal bruising, swelling or pain following the procedure. Many return to normal activities immediately.

6. Is RFA suitable for all varicose veins?

The majority of varicose vein can be treated with RFA. However, the procedure is mainly for large varicose veins. It is not suitable for veins which are too small or too tortuous, or with an atypical anatomy. There are many other alternatives for treating varicose or spider veins. Our specialists can help you choose the best option.





Reference information: http://veno.com.hk/radiofrequency-vein-ablation.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment. 

RadioFrequency Ablation (RFA) (1)

1. What is the Radiofrequency Ablation of Varicose Vein?

RFA a minimally invasive treatment alternative to the traditional vein stripping surgery for varicose veins and gives better cosmetic results with less scarring. The principle is that by removing the abnormal vein by applying radiofrequency energy inside the vein (‘endovenous’) to destroy (‘ablate’) it.

2. How is RFA done?

The procedure is performed on an outpatient basis with the patient awake. The entire procedure is done under ultrasound visualisation. After a local anaesthetic is injected into the thigh area, the laser fibre is threaded into the vein through a small puncture hole. Then radiofrequency energy is released which heats up the wall of vein and causes it to collapse. Radiofrequency energy is released continuously as the fibre moves along the whole length of the diseased vein, resulting in the collapse and ablation of the varicose vein. Following the procedure, a bandage is placed over the entry site, and additional compression is applied. Patients are then encouraged to walk and resume all normal activities

3. How is RFA of varicose vein different from conventional surgery?

RFA does not require general anaesthesia and is a less invasive procedure than vein stripping. The recovery period is also shorter than surgery. Patients usually have less post-operative pain, less bruising, faster recovery, fewer overall complications and smaller scars.

..........cont'l



Reference information: http://veno.com.hk/radiofrequency-vein-ablation.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment. 

Abdominal Aortic Aneurysm (AAA) Infographic series (2)

What are the symptoms of AAA?
 
AAA is usually symptom free before it ruptures, which makes it difficult to detect at an early stage. Some patients may feel a pulsatile mass in their tummy. Any symptoms of abdominal or back pain in an AAA patient is suggestive of rupture aneurysm. Urgent medical assessment is necessary.

Who will have AAA?
 
Smoking, aging, diabetes, high cholesterol and hypertension are the major risk factors of developing AAA and males are at greater risk than females.

 
How to diagnose AAA?

 
Despite the difficulty of detecting AAA at an early stage, a simple ultrasound scanning of the abdomen can already accurately diagnose AAA. Further detail imaging with CT scan, MRI, or angiogram are only necessary when surgical intervention of the AAA is necessary. Although the mortality rate of a ruptured AAA is high, it is still preventable. Quitting smoking, controlling high blood pressure, regular exercise and a healthy diet will contribute to reducing the risks of developing AAA.

When & how to treat AAA?
 
Surgical intervention of the AAA is necessary when the size of the aneurysm is > 5cm in diameter. We want to fix the aneurysm before it ruptures.

There are currently 2 treatment options for AAA. Endovascular Aneurysm Repair (EVAR) is a minimally invasive surgery involving only small wounds at the groins. It is associated with less pain, faster recovery, and is safer compared with open surgery.

The traditional open repair of AAA involves large abdominal wound. Although it is more durable, it is more invasive and is currently reserved for cases with anatomy not suitable for EVAR.

Reference information: http://esteemmedical.com.hk/aortic-aneurysms.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment. 

Abdominal Aortic Aneurysm (AAA) Infographic series (1)

What do you need to know about Abdominal Aortic Aneurysm?
Abdominal Aortic Aneurysm (AAA) is becoming more and more common in Hong Kong and is known as a “silent killer” due to its asymptomatic nature. The prevalence of this disease is global. U.S and U.K have seen 15,000 deaths [1] and 6,000 deaths [2] respectively caused by ruptured AAAs. In Hong Kong, more than 1,000 new cases of aortic aneurysm are reported every year. It’s important to increase public awareness and understanding around the disease.


The series will look into:
1: What is Abdominal Aortic Aneurysm (AAA)?
2: How common is AAA?
3: How dangerous is AAA?
4: What are the symptoms?
5: Who will have AAA?
6: How to diagnose AAA?
7: When & how to treat AAA?

An abdominal aortic aneurysm is an abnormally dilated area in the lower part of the aorta within the abdomen [3] . The fact that it is asymptomatic means the aneurysm is often left unnoticed and unattended promptly.

 
How common is AAA?

How dangerous is AAA?

When the aorta becomes dilated, it behaves like blowing up a balloon. When the balloon is too excessively blown up, it will rupture. Usually when the size of aneurysm is >5cm, there is significant risk of rupture. Rupture AAA can cause massive bleeding within short period of time.

The overall mortality rate of a ruptured aneurysm can be as high as 100% and the risk of rupture increases as the size of the aneurysm expands. Once internal bleeding is caused by the rupture of aneurysm, it becomes a life-threatening condition.

 .......cont'l




Reference information: http://esteemmedical.com.hk/aortic-aneurysms.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment. 

What is Peripheral Arterial Disease?

Peripheral arterial disease (PAD) is a chronic disease usually due to atherosclerosis, when the atheromatous plaque cause thickening of the arterial wall, resulting in narrowing or occlusion of the arteries. This problem can occur in all arteries from the body, but one of the commonest site is the arteries of the legs.

What are the risk factors of PAD?

The following are the risk factors of atherosclerosis and its associated diseases which could increase the risk of developing cardiovascular and cerebrovascular diseases.
 
These include:

• Aging (over 50 years old);
• Smoking;
• High cholesterol;
• Diabetes;
• High blood pressure;
• Chronic kidney disease;

High plasma levels of homocysteine elevated fibrinogen concentration;
Personal history of vascular disease, heart attack or stroke, and
Family history of premature atherosclerosis.

Patients with PAD are suggested to have evaluation and control of underlying cardio and cerebrovascular diseases, and atherosclerosis risk factors.

 
Clinical Classification of PAD

The varieties of signs and symptoms present help doctor to stage the severity of PAD for patients. The most commonly used methods are the Fontaine and Rutherford classification which classify the disease based on the following 4 categories of symptoms:

Asymptomatic: Most of the patients are asymptomatic, but with clinical examination such as palpation and checking the Ankle-Brachial Index (ABI) may reveal cold extremities, and other signs of incomplete blood vessels obstruction.



Intermittent Claudication (IC): Fatigue; heaviness; tiredness or cramping in the lower extremity precipitated by walking or exercise and relieved with rest. The location of the pain depends on the site of occlusion of the artery, but the commonest site is at the calf.

 

Critical Limb Ischaemia (CLI): Leg pain persist even at rest; decrease temperature of leg; toe or leg sores, wounds that do not heal, or heal very slowly; loss of hair on the skin; brittle nail, with absent or diminished pulse in the legs. Patients in this condition must be referred to a vascular surgeon ASAP to prevent limb loss.

 

Ulceration or gangrene: Minor to major tissue loss due to severe arterial occlusion, with non-healing wound in foot & ankle, or the toes turn black in color. Patients with this condition must be urgently referred to a vascular surgeon for revascularization in order to salvage the limb.

Reference information: http://esteemmedical.com.hk/peripheral-arterial-disease-cause.html 
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment.