Lymphatic and venous examination of the ulcerated leg: a preliminary report.

BACKGROUND: It has been widely accepted that deep venous thrombosis and venous incompetence initiate a series of events resulting in various ulcerations. The role of the lymphatic system in the progression of these events has not been extensively studied. METHODS: Twenty-three patients with nonarterial ulcerations of the legs were examined by phlebography and lymphangiography. All had recurrent ulcerations associated with nonpitting edema, brawny induration, and dermatitis characteristic of the postphlebitic syndrome. Arterial circulation was normal in all patients. RESULTS: Phlebographic abnormalities found were the presence of communicating vein incompetence in all 23 patients, varicose veins in six, and deep venous occlusion in one. Lymphatic abnormalities were also present in all patients. Extravasation in the area of the ulcer was seen in eight patients, dermal backflow in six, tortuosity and irregularity of the channels in four, and retention of contrast agent for more than 24 hours in seven. CONCLUSIONS: Significant abnormalities of the lymphatic system exist in patients with leg ulcers caused by the postthrombotic syndrome.