title: Holistic management of venous ulcers especially with endovenous laser treatment using 980nm laser in an ethnically diverse society.
abstract: OBJECTIVE
  Chronic venous ulcers usually occur as an occupational hazard due to venous insufficiency with venous hypertension. Endovenous laser treatment (EVT) is used to treat varicose veins with venous ulcers and outcome including demography assessed in the different races.
  
  
  METHODS
  145 lower limbs(right 39.3%, left 60.7%) with venous ulcers involving reflux of the great saphenous (132 cases) and / or small saphenous (57 cases) veins underwent EVT with 980 nm diode laser for single (123 cases) or both (11 cases) legs intervention. Supplementary procedures required multiple avulsions and / or sclerotherapy. Holistic advice of multilayered bandaging, graduated compression stockings, weight reduction and lifestyle changes enforced.
  
  
  RESULTS
  The average age with venous ulcers was 53.6 years.The mean BMI was 26.8 : the Chinese, Indian and Malay BMIs were 25.1, 28.1 and 31.3 respectively. Symptoms that included pain, swelling, heaviness and cramps assessed pre- and postsurgically were significantly reduced (<0.0001), using the Wilcoxan signed rank test. Of the occupations involved by race, the Chinese were mostly salespersons, Indians blue collar workers and Malays foodrelated workers. Young overweight Indians with sedentary occupations were most predisposed to venous ulcers. Gram negative organisms 63.4% and gram positive organisms 36.6% were isolated in the ulcers. Most ulcers 63.5% measured <2 cm and majority 73.8% localised in the gaiter area.
  
  
  CONCLUSIONS
  Results of EVT in healing ulcers with no recurrences more than 2 years were successful in 89.7% (130/145). Complications included numbness foot 7.5% and DVT 1.4%. 10.3% (15 cases) had recurrence of venous ulcers within 2 years. In terms of satisfaction 32.3% experienced as very satisfied while 63.4% were satisfied and 4.3% unsatisfied. In conclusion EVT is a useful adjunct with with minimal invasion in managing venous ulcers holistically.
authors.affiliation: Penang Adventist Hospital, 465 Burma Rd,10350 Penang, Malaysia. murli9415@gmail.com.
authors.forename: N L
authors.initials: NL
authors.lastname: Murli
authors.affiliation: Gleaneagles CRC, 3rd Floor Gleaneagles Medical Centre, Pangkor Rd, 10050 Penang, Malaysia.
authors.forename: T C
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Gleaneagles CRC, 3rd Floor Gleaneagles Medical Centre, Pangkor Rd, 10050 Penang, Malaysia.
authors.forename: M L
authors.initials: ML
authors.lastname: Beh