2. Painful swollen limb

3. Case
A 28-year-old women was seen by her family physician for routine pregnancy check-up at 36 weeks gestational age. Neither the patient nor the physician had any concern about the pregnancy. However patient did complain of the unilateral swelling of her left leg, which has gradually increased over the previous 2 days. Furthermore, evening before her visit she developed some sharp chest pain, which was exacerbated by deep breaths.

5. LEG Part of the lower limb between the knee joint and ankle joint
Major structures pass through
Proximal------popliteal fossa
Distal Tarsal tunnel

6. Leg
Bony Framework

7. Interosseous membrane

8. Leg Compartments
Muscles in the anterior compartment of leg dorsiflex the ankle, extend the toes, and invert the foot.
Muscles in the posterior compartment plantarflex the ankle, flex the toes, and invert the foot.
Muscles in the lateral compartment evert the foot.
Major nerves and vessels supply or pass through each compartment.

9. Superficial group of muscles in the posterior compartment of leg

10. Deep group of muscles in the posterior compartment of leg.

11. Arteries in the posterior compartment of leg.

12. Tibial nerve

13. Muscles in the lateral compartment of leg

14. Muscles of the anterior compartment of leg

15. Common conditions affecting the Leg
Peripheral neuropathy (particularly associated with diabetes mellitus)
Lumbar nerve root lesions (associated with pathology of the intervertebral discs)
Fibular nerve palsy

16. The deep and superficial veins of the legs
The veins of the legs are divided into two systems
the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and
the superficial veins (which run in the layer of fat just beneath the skin).
The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose.

18. VENOUS SYSTEM (LOWER LIMB)
I- Superficial System: (Superficial to deep Fascia).
1- Long saphenous vein: start 1cm above and anterior to the medial malleolus and pass through the antero-medial aspect of the leg and thigh to open into the femoral vein through the saphenous opening.
2- Short saphenous vein: start above the ankle joint in the post. aspect of the leg midway between lateral malleolus and tendoachilis & end in the popliteal vein with variable course.

19. II. Deep system: Veins in the soleus muscle Ant. & post
II. Deep system: Veins in the soleus muscle Ant. & post. tibial veins in the leg form the popliteal vein which is the major tributary to the femoral vein. The deep system lies deep to deep fascia.

20. III- Communicating system: Perforating veins communicating between sup & deep systems: 1- At Saphenofemoral junction. 2- At the middle of the thigh. 3- Just above the knee. 4- Just below the knee. 5- Just above the ankle.

22. DEEP VENOUS THROMBOSIS (DVT)

23. DEFINITION
Deep vein thrombosis (DVT) is a medical condition in which blood clots form within the large veins of the body, such as the calves and thighs, or also sometimes in the pelvis, chest, or arms.
These blood clots impede the circulation of blood and nutrients to the limbs, as well as to various organs and body systems. Such clots may become very dangerous if they break off because they can travel to another part of the body such as the lungs, brain, or heart and block circulation to that organ.
This may result in severe tissue damage and create a life-threatening situation if the clot is left untreated.

24. Causes of DVT age - as people over 40 are at greater risk of DVT
a past history of DVT
a family history of DVT
an inherited condition that makes the blood more likely to clot than usual1
immobility
obesity
recent surgery or an injury, especially to the hips or knees
Pregnancy, having recently had a baby
having cancer and its treatments
taking a contraceptive pill that contains estrogen - but most modern pills contain a low-dose, which increases the risk by an amount that is acceptable for most women
hormone replacement therapy (HRT) - but for many women, the other benefits outweigh the increase in risk of DVT
treatment for other circulation or heart problems

25. DVT

26. PATHOGENESIS

28. CLINICAL FEATURES

29. DUPLEX SCAN

30. TREATMENT
Compression
Elevation
Immobilization
Anticoagulation

31. COMPLICATIONS

33. VENOUS DISEASES

34. ANATOMY OF SAPHENOUS VENOUS SYSTEM

35. VALVES AND PERFORATORS

36. VALVES IN THE VEINS

37. MUSCLE PUMP

38. MECHANISM OF VALVES

39. VARICOSE VEINS

40. Definition
The term ’varicose vein’ refers to veins that are abnormally large and tortuous. This term applies to both the large protruding veins within the superficial subcutaneous fascia and the smaller ”spider veins” that occur just beneath the epidermis

41. Why do veins become varicose?

43. Who gets varicose veins?

44. Sex
Among the general population in the Western World, about 20 to 30 per cent of women have varicose veins.
Age
More people develop varicose veins as they get older – at least up to the age of about 60.
Heredity
It is not unusual for varicose veins to ‘run in the family’ to some extent, but there is no well-proven genetic basis for varicose veins.

45. Height and weight
Pregnancy
Diet and bowel habit
Occupation and posture

46. What trouble do varicose veins usually cause? (Signs and Symptoms)

47. Cosmetic embarrassment
This is by far the most common problem that varicose veins cause, and is perfectly understandable in a society that makes women want to have nice looking legs.

49. Ankle swelling
Varicose veins can cause ankle swelling in a few people, as the pressure in the veins causes fluid to be squeezed out into the tissues as they stand, sit with their feet on the ground or walk about. The swelling goes away after a night in bed.

50. Varicose veins can cause more serious chronic problems

51. Venous eczema (‘varicose eczema’)
The first sign of trouble is often mild eczema and itchiness of the skin – usually just above the ankle.
This can be just a small patch, or a larger area.

52. Venous Eczema

53. ULCERS

54. ARTERIAL DISEASES

55. ATHEROSCLEROSIS

59. PATHOGENESIS

60. PATHOGENESIS

63. ARTERIOGRAMS

64. Anterior
Lateral
COMPARTMENTS
Deep Posterior
Posterior

65. Definition: An increased pressure within enclosed
osteofascial space that reduces capillary per-
fusion below level necessary for tissue
viability; the underlying mechanism is:
- increased volume within space
- decreased space for contents
- combination of both

66. Etiology Trauma with bleeding/swelling Bleeding disorders Burns
Tight wraps
Traction
Surgical positioning
Pneumatic antishock garment
Reprefusion swelling

67. Increased compartment pressure leads
Pathophysiology:
Increased compartment pressure leads
to increased venous pressure which decreases A-V gradient resulting in muscle and nerve ischemia.

68. Clinical Diagnosis The six ‘Ps’: Pressure Pain Paresthesia Paralysis
Pallor
Pulselessness

69. Leg Single Incision Technique

70. Leg Two Incision Technique

72. This picture shows a red and swollen thigh and leg caused by a blood clot (thrombus) in the deep veins in the groin ( compression of the left external iliac veins by the gravid uterus was the likely cause of stasis which lead to deep venous thrombosis

73. THANK YOU