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What about medium distance hikes of 5-10 miles that include hills? Tafazzoli A, Rostan EF, Goldman MP. Ma RW, Pilotelle A, Paraskevas P, Parsi K. Three cases of stroke following peripheral venous interventions. Such complications are usually self-limiting and transient in nature, and they can be treated with topical agents.3 The possible side effects include: (ii) injection site reactions (injection pain, pruritus, minor bruising, wheals, local swelling, indurations, and erythema) that are self-limited; (ii) skin irritation (itching and an irritant contact dermatitis may follow the use of compression stockings) and excessive skin xerosis that can be treated effectively with emollient creams or oils; (iii) tape compression blister that can be prevented by using a tubular support bandage, and the resolution occurs within 1 to 2 weeks without any adverse sequelae. National Women's Health Information Center. Severe deep venous thrombosis, proximal or extensive, is rare. However, new veins may appear, and if they become problematic, a person may need repeated treatments. Leslie-Mazwi TM, Avery LL, Sims JR. Intraarterial air thromnogenesis after cerebral air embolism complicating lower extremity sclerotherapy. In the study by Gillet et al,2 1 case of pulmonary embolism was reported in 1025 patients. How long should this last? The vast majority of reported deep venous thrombosis cases are localized to the lower legs. Tell your provider if it hurts a lot. In some patients, the etiology is multifactorial and involves a combination of obesity, lack of exercise, concomitant drugs, such as calcium channel blockers, and a lack of compliance with the use of medical compression systems.3 This complication may be minimized by using careful techniques to avoid phlebitis and deep vein occlusion. 2010;25(5):261-266. People with varicose veins or spider veins might consider sclerotherapy if the veins are too twisted for other treatments to work or if they have uncomfortable symptoms, such as: A doctor assesses the problematic veins or lymph vessels before recommending this approach. 27. The information on RealSelf is intended for educational purposes only. Some veins need more than one sclerotherapy treatment. Sclerotherapy is typically done in a health care provider's office. swelling - may occur in people who have had large veins treated. During the procedure, a doctor uses a fine needle to inject the sclerotherapy solution into the varicose or spider vein. 1979;64(2):145-150. Matting after extensive foam sclerotherapy oftelangiectasia in the lateral thigh with underlying reflux in thereticular veins.The underlying reflux resolved with treatment of the reticularveins at a lower volume and concentration of sclerosant and theuse of medical compression stockings, and finally resolved withsclerotherapy of telangiectasia using glycerin. The sclerotherapy solution causes the vein to scar. Many use compression hose following scleraotherapy for varying times, and listen to your doctor on his method. Photographs will be taken before treatment is initiated. 45. What is in the saline solution they use in Sclerotherapy? Brzoza Z, Kasperska-Zajac A, Rogala E, Rogala B. Anaphylactoid reaction after the use of sodium tetradecyl sulphate: a case report. Cutaneous hyperpigmentation following venous sclerotherapy treated with deferoxamine mesylate. 2012;27(8):383-389. You do not need anesthesia or sedation for sclerotherapy. 19. Middle cerebral air embolism after foam sclerotherapy. Dehydration or el you really should go see a doctor and have a proper examination of your genitals. run? Hemosiderin deposition after sclerotherapy usually occurs because either the blood from the treated varicose vein leaks out into your tissue, staining them, or blood clotting within the treated vein, and keeping the area inflammed and "hard." Answered by Austin Vein Specialists (View Profile) Gillet JL, Guedes JM, Guex JJ, et al. Q-switched ruby laser treatment for postsclerotherapy hyperpigmentation. The clot will fade and heal after time, but if the area continues to grow in size and/or become more painful, I would be a good idea to find a physician or nurse practitioner who would drain that clot. Foam sclerotherapy for reticular veins and nontruncal varicose veins of the legs: a retrospective review of outcomes and adverse effects. Sclerotherapy is usually a minor, noninvasive procedure to treat issues such as varicose veins or hemorrhoids. Bush RG, Derrick M, Manjoney D. Major neurological events following foam Sclerotherapy. Phlebology. 2012;27(8):430-433. How long does it take for Sclerotherapy to work? No, there is not a way to speed up healing/fading of pigmentation. Figure 5. Very rare major complications could benefit from multicenter registers to provide evidence-based treatments. Scultetus AH, Villavicencio JL, Kao TC, et al. Sclerotherapy usually works best on small varicose veins. Side effects that can occur where the needle goes into the skin include: These side effects usually go away within days to weeks. When sclerotherapy does not work, people may require other treatments, such as surgery. Galanaud JP, Gentry C, Sevestre MA, et al; OPTIMEV SFMV Investigators. 2011;27(4):147-167. Hyperbaric oxygen may minimize reperfusion tissue injury by optimizing the oxygenation, inhibiting neutrophil migration, and minimizing proinflammatory cytokine production.27 This treatment has been successfully used to prevent necrosis following a single case of an intra-arterial injection of sclerosants.25 As its occurrence is extremely rare, it is recommended that an emergency flow sheet be readily accessible (Table II). Following sclerotherapy, the treated veins can clot or blood can escape from the treated veins and form around these veins. This may involve avoiding certain medications, such as aspirin or blood thinners, or using lotions on the area of treatment. A mill wheel murmur may be produced by movement of bubbles in the right ventricle.28 A cerebral gas embolism can present with confusion, focal neurological symptoms, and stroke.28,38-41, The neurological events may be self-limiting, which would necessitate a nonspecific treatment. Then your care provider uses a small needle to slowly put solution into the vein. Generally coagulumthat is a result of sclerotherapy is removed within a two week period following treatment. Dermatol Surg. The prevention of cutaneous necrosis following extravasation of hypertonic saline and sodium tetradecyl sulphate. Good technique, satisfactory imaging, general precautions, and compliance with post treatment instructions may help avoid some of the adverse events. A doctor can help a person decide if sclerotherapy is necessary or suitable. Even though complications can happen even to the most experienced practitioner, it is mandatory to know what they are and how to manage them. (photos) Had sclerotherapy done first week in Dec. Why is it necessary to wear Compression Stockings after Sclerotherapy? The role of serum iron levels and the effectiveness of treatment with the copper vapor laser. Figure 7. 47. Given the proximity of nerves to arteries, arterial injury can result in perineural swelling and significant neuropathic pain. Several thing. Larger veins might take 3 to 4 months. I had a sclerotherapy treatment, but instead of being prescribed compression stockings, my doctor advised me to use an elastic bandage. Don't shave your legs or use lotion on them. Gillet JL, Lausecker M, Sica M, Guedes JM, Allaert FA. 5)flushing the area of discoloration by injection of sterile water or saline is this typical or possibly from compression socks? Plast Reconstr Surg. Complications and adverse sequelae of sclerotherapy. Phlebology. Phlebolology. How long before this goes away? Healthcare services not covered by health insurance. 7 days post-sclerotherapy and having leg/muscle twitching all over legs. Phlebology. A very tiny needle is inserted into the vein and the drug simply pushed through the syringe in tiny amounts. Neurocrit Care. Before the procedure, a health care provider does a physical exam. 43. International Headache Society. Patients with superficial venous thrombosis have a 5% to 40% chance of developing deep venous thrombosis.56, Deep venous thrombosis can be ruled out in patients with superficial phlebitis using an ultrasound evaluation.56 Most patients have minimal phlebitis and require no treatment or a simple drainage of an associated coagulum with a 22-gauge needle.6 In symptomatic patients, drainage of the thrombi after liquefaction, approximately 2 weeks after sclerotherapy, hastens resolution of the otherwise slow and painful resorption process.6 Adequate compression and frequent ambulation should be maintained until the pain and inflammation resolve. It can help with varicose veins or spider veins. 1)drainage (although you said your doctors did not advise this) Lieberman PL. 2007;94(8):925-936. 77. Removing the trapped blood is the best treatment. The solution, usually a liquid, works by irritating the lining of the vein, causing it to swell shut and block the flow of blood. Would I see the results right away after Sclerotherapy treatment? 39. This is likely if the veins are causing symptoms. But call your health care provider for problems with moving or feelings in arms or legs after the procedure. Phlebology. In addition, Yag laser penetrate deeper allowing complete resolution of the hemosiderin stainings. Venoarterial reflex vasospasm clinically presents with prolonged blanching of the skin a few centimeters away from the site of injection, followed by cyanosis and reactive erythema. 2005;31(2):123-128. The patient should be placed in the Trendelenburg position and observed. Place the tip of the paper clip on the nail and let it melt through. Walking and moving helps keep blood clots from forming. 2007;13(6):87-89. Semin Cutan Med Surg. 7).65 Continued use of compression is recommended, and evaluation for an underlying source of venous insufficiency is indicated for persistent intravascular coagulum.65. Phlebology 95. Red, raised and perhaps stinging areas of skin at the injection site, which disappear shortly after treatment. Yag is the laser of choice for these sclerotherapy complications because we are ultmately dealing with hemoglobin and iron, which absorb 1064nm lasers the best. I had sclerotherapy almost 4 weeks ago. Some may have the procedure for cosmetic reasons. Gillet JL. Sclerotherapy ( sclero- meaning hardness and -therapy meaning treatment) is an in-office procedure used to address venous swelling or the abnormal accumulation of fluids in tissues. How long does it take for telangiectatic matting to resolve following a sclerotherapy session? For example, people can usually treat hemorrhoids with strategies such as lifestyle changes, eating more fiber, and not straining when having a bowel movement. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. 2007;58(5):644- 646. 41. Wright D, Morrison N, Recek C, Passariello F. Post ablation superficial thrombus extension (PASTE) into the common femoral vein as a consequence of endovenous ablation of the great saphenous vein. 2006;117(2):391-397. The thrombi are apparent by ultrasound within 3 to 7 days of treatment, are nonocclusive, asymptomatic, and rarely identifiable after 14 days. 2021; doi:10.1002/14651858.CD001732.pub3. Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, All you need to know about varicose vein pain, an infection, which requires treatment with antibiotics in, a skin injury that may result in a small, permanent scar, an allergic reaction to the injected solution, maintaining a healthy weight, to relieve excess pressure on the veins and improve blood flow, avoiding long periods of sitting or standing, or sitting with the legs elevated above the heart, stay physically active to help promote blood flow, after discussing a suitable exercise plan with a healthcare professional, endovenous ablation, which uses lasers to close off the vein, surgically removing smaller veins that are closer to the surface of the skin, surgically tying up and removing larger veins. These side effects usually go away within days to weeks. 2014;29(6):338-354. Do they go away after delivery? While this is usually self-limiting, it may take 3 to 6 months to resolve.6 Decreasing inflammation with NSAIDS, which speeds up the resolution in minor cases, and possible long-term therapy using neurotropic agents are the recommended treatments. A topical application of a strong-potency corticosteroid cream, lotion, or gel has been found useful.6, Systemic causes should be identified and excluded. 12. Postsclerotherapy hyperpigmentation: treatment with a flashlamp-excited pulsed dye laser. 2011;26(7):280-284. 5. Springer-Verlag; 1995:550-551. It is the most common cause of a simple loss of consciousness.11 The vasovagal reflex is a common adverse sequelae of any surgical or invasive procedure. Chest. Advertising revenue supports our not-for-profit mission. They are common in people's legs as, A look at varicose vein pain, a condition where swollen veins become painful. Guex JJ, Allaert FA, Gillet JL, Chleir F. Immediate and midterm complications of sclerotherapy: report of a prospective multicentre registry of 12,173 sclerotherapy sessions. Gutirrez, L. R. (n.d.). 2011;26(4):140-147. 1999;25(2):105-108. Phlebology. Or use sunscreen with at least 30 SPF. Had an ultrasound to confirm it. Hafner F, Froehlich H, Gary T, Brodmann M. Intra-arterial injection, a rare but serious complication of sclerotherapy. As other very rare entities, they would benefit from a multicenter register coordinated by an international phlebological association, to obtain enough numbers to provide management recommendations based on evidence or consensus. The patient was on observation until the clinicaldisturbances disappeared and she was discharged. 4)compression stocking use After the vein is damaged the body needs time to heal. I have been wearing support knee highs. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Sclerotherapy is a nonsurgical procedure. 28 A cerebral gas embolism can present with confusion, focal neurological symptoms, and stroke. 2)excercise 6th ed. If by low blood you are referring to anemia, symptoms may include feeling tired or cold. Can essential oils reduce varicose veins? Sclerotherapy is typically performed on the legs for conditions such as telangiectasis, venulectasias, and reticular ectasias, all of which are different kinds of varicosites. They may use ultrasounds to guide them. Scientists use genetic rewiring to increase lifespan of cells, Beyond amyloid and tau: New targets in developing dementia treatments, Napping longer than 30 minutes linked to higher risk of obesity and high blood pressure, Activity 'snacks' could lower blood sugar, complication risk in type 1 diabetes, In Conversation: Investigating the power of music for dementia. J Allergy Clin Immunol. The V-Beam, manufactured by Candela Medical is a very successful device for clearing these unwanted vessels. The more blood trapped, the larger the reservoir of iron potentially being left in the skin. Also, sclerotherapy may not be not suitable for people who are pregnant, breastfeeding, or confined to bedrest. 1. Ankle edema occurs much less frequently if the sclerosing solution is limited to 1 mL per ankle. The patientwas managed with intramuscular epinephrine, intravenousantihistamines, bronchodilator therapy, intravenous line withsodium chloride solution, and 100% O2, and the treatmentoccurred while the patient was in the Trendelenburg positionwith continuing evaluation of neurologic, cardiovascular, andrespiratory systems. What happens if I don't wear compression stockings after sclerotherapy? J Dermatol Surg Oncol. Research suggests that sclerotherapy removes problematic veins in 7590% of cases, but this typically requires multiple treatments. Try laser treatments to lighten the staining. Access to hyperbaric oxygen therapy may also be considered in emergency planning. Weiss RA, Sadick NS, Goldman MP, Weiss MA. 1974;61(2):124- 126. Wear loose, comfortable clothing. To reduce this risk, a doctor only injects a small amount of solution at a time, and they encourage the person to move their legs to support proper blood flow. Efficacy of graduated compression stockings for an additional 3 weeks after sclerotherapy treatment of reticular and telangiectatic leg veins. J Vasc Surg Venous Lymphat Disord. Outcome of ultrasound-guided sclerotherapy for varicose veins: mediumterm results assessed by ultrasound surveillance. Thromb Haemost. It has been suggested that rightto- left shunts might be a factor, allowing foam bubbles to pass into the arterial circulation.28,35-37, Stroke is a very rare, but significant, complication of sclerotherapy.38-42 Ma et al reported two cases of stroke following 4059 foam procedures in a 6-year period, yielding an incidence of 0.01%.41 Parsi reviewed 13 cases of stroke occurring after sclerotherapy that were published since 1994.28 Four cases followed liquid sclerotherapy and nine followed foam sclerotherapy; 3 patients had a partial recovery, while the others had a complete recovery. By clicking the "Subscribe" button, you agree to our Terms of Use and Privacy Policy. A nonocclusive, postsclerotherapy, deep venous thrombosis located in the lower legs has a benign evolution and a rapid recanalization with ambulation, compression, NSAIDS, or short treatments with anticoagulation, usually with low-molecular-weight heparin.2 Coleridge Smith managed distal and not completely occlusive deep venous thrombosis without anticoagulation.53 Gillet et al showed that, in asymptomatic patients with nonocclusive distal thrombosis, a follow-up with duplex ultrasound and no anticoagulation is probably the best option, except for patients with risk factors for venous thromboembolism.52 Oral anticoagulation for 3 weeks to 3 months has also been successfully used.54 For extended deep venous thrombosis, Guex suggests looking for risk factors for venous thromboembolism.55, The definition of phlebitis after sclerotherapy in the literature is controversial. Although spontaneous resolution occurs in 70% of cases at 6 months, pigmentation may persist longer than 1 year in up to 10% of patients.2,6,63 Hyperpigmentation is usually due to a combination of both melanin and hemosiderin pigment deposits secondary to either direct hemosiderin deposition, post-inflammatory processes, or a combination of the two. J Allergy Clin Immunol. AskMayoExpert. Complete recovery was only reported in one case, whereas amputation could not be prevented in two cases.24 In cases where cellular lysis has already taken place and microcirculatory obstruction is caused by a sludge of cellular degradation, thrombolysis might be ineffective. 2004;34(suppl 16):55. 2007;10(1):29-32. Sclerotherapy may not be effective for everyone. Vascular. Post-sclerotherapy compression: controlled comparative study of duration of compression and its effects on clinical outcome. 2006;47(1):9-18. Most people return to their regular activities on the same day, but you might want to have someone drive you home after the procedure. 35. Do Not Sell or Share My Personal Information. It is darker red when it carries less. Patent foramen ovale and other cardiopulmonar right-to-left shunts are the most consistent risk factors.9 The etiology of neurological symptoms following sclerotherapy is currently unknown. What you describe are common occurrences following sclerotherapy. Varicose veins are usually in the legs. The outlook is good, as the procedure is typically safe and effective. 3. The majority of these will dissolve spontaneously over time and could take up to one year. Is the bandage just as effective as compression stockings? 26. It is harmless, and sometimes can be diminished with surface laser treatment. Microthrombectomy reduces postsclerotherapy pigmentation: multicentre randomized trial. This can occur within one week after laser or radiofrequency ablation or 3-6 weeks after foam sclerotherapy treatments. In the past, a copper vapor laser73 and a 510 nm flashlamp excited pulsed-dye laser74 proved the most effective with 69% and 45% efficacy in patients with pigmentation lasting 12 or 6 months, respectively. It involves a doctor inject a solution that causes the problematic veins to shrink and collapse. If untreated, the inflammation and clot may spread through perforating veins to the deep venous system. 28,38-41 Treatment The neurological events may be self-limiting, which would necessitate a nonspecific treatment. J Dermatol Surg Oncol. Sclerotherapy is usually done to make the veins look better. Dermatologic Surgery. Side effects that can occur where the needle goes into the skin include: Bruising. A complete ophthalmologic and neurologic examination is recommended. Treatment of severe post-sclerotherapy hyperpigmentation with Q-switched ruby laser. In my experience evacuating trapped blood takes on an average of one to three attempts. All rights reserved. They will either be removed a few weeks after the injection or will clear by themselves. How soon after sclerotherapy can I play tennis, run, and dance? Our improved knowledge of complications allows us to implement the treatment carefully. Sclerotherapy frequently results in the formation of a coagulum within the treated vessel. Cutaneous necrosis after extensive sclerotherapy withfoam in an older woman with long-term reticular veins andtelangiectasia in retromaleolar area.The patient also suffered from severe edema and inflammationof the ankle, which improved with nonsteroidal anti-inflammatorydrugs, medical compression stockings, and local corticosteroids. Compression in the treatment of leg telangiectasia: a preliminary report. This swelling cuts off the flow of blood or lymphatic fluid, and the vessel shrinks. Around 10, Hemorrhoids, or piles, are common irritations around the rectum and can be extremely painful. Are those on my legs reticular veins, or could they be normal veins? Doctors may also use it to treat blood and lymph vessel disorders that cause vessels to form incorrectly. Sclerotherapy is an effective and safe treatment when used by trained and careful hands. 34. Smith PC. Jauch EC, Saver JL, Adams HP Jr, et al. Dermatol Surg. What chemicals are in the saline solution and does it have mercury in it and if not what is in it? 1992;18(5):417- 422. 1993;19(10):953- 958. This content does not have an English version. How long does it take to see spider veins vanish after Sclerotherapy? https://www.uptodate.com/contents/search. if any burning check UA otherwise rest for 1 wk. Local care to the area with warm compresses will help. 2000;26(7):653-656. Spider veins usually respond to the treatment in 36 weeks, and larger veins usually respond in 34 months. (like in veins). Sclerotherapy is an elective procedure and although the chances of developing DVT ar Would wait at least a few weeks if possible, especially if larger varicose veins were treated. Sclerotherapy also treats spider veins, a mild form of varicose veins. Morrison N, Neuhardt DL. My treating pysician does not drain these, is there any way to speed up the healing/fading of pigmentation? Rub/massage the area several times a day, or whenever you get a chance. 74. That will speed up the healing. Much of the treatments were injecting "feeders". Sclerotherapy usually produces some temporary discomfort. This issue may be painful and itchy and cause skin discoloration. It can help with varicose veins or spider veins. Eur J Vasc Endovasc Surg. From my picture you can't tell but I also seem to have stagnant blood in the vein as well. Is the ketogenic diet right for autoimmune conditions? J Vasc Surg. Bruising from sclerotherapy still prominent 12/13 weeks later, advice? In addition, patients should be evaluated carefully for deep venous thrombosis, a pulmonary embolism, and a right-to-left shunt. For severe respiratory symptoms, use a 4 g/kg intravenous bolus of salbutamol and, later, it is recommended to use 5 to 10 g/minute as a continuing infusion. 53. 59. Table I. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. I would love to cut off the feet of my compression stockings. N Engl J Med. Other treatments you've had for varicose veins and the results. Post-sclerotherapy, some patients may notice hyperpigmentation occurs especially with large surface leg veins, but sometimes spider veins too. I have bruising from Sclerotherapy injections that I had 8 weeks ago is this normal? I never had them until my pregnancy last year. Jia X, Mowatt G, Burr JM, Cassar K, Cook J, Fraser C. Systematic review of foam sclerotherapy for varicose veins. 36. A person may need to have a follow-up appointment with their doctor for a physical examination and possibly imaging or blood tests to check the effects of the sclerotherapy. (n.d.). Telangiectatic matting may affect one-third of patients undergoing sclerotherapy, and usually resolves spontaneously in 3 to 12 months.62 In many cases, inadequate or no treatment of the underlying reflux is the cause of telangiectatic matting (Figure 5).63,64 The precise cause of telangiectatic matting remains unknown, but its development is attributed to a reactive inflammatory or angiogenic mechanism, and it is more prevalent with high concentrations or volumes of sclerosant or high-infusion pressures that can result in inflammation o excessive vein obstruction (Figure 6).63,64 Patient risk factors include excessive body weight, female sex, hormone treatments with estrogens, a longer duration of spider veins, and a family history of telangiectasia.61,63,64. Phlebitis can be related to the foam sclerotherapy, and they may be able to remove some of the "trapped blood" to relieve some of your discomfort. 2011;105(1):31-39. J Am Acad Dermatol. Insist on drainage of these areas at the treating clinic or find another that will. Extensive tissue necrosis following highconcentration sclerotherapy for varicose veins. Skin necrosis from extravasation of intravenous fluids in children. Munavalli GS, Weiss RA. Since this was done for cosmetic reasons, in part, I would think long term appearance does matter. If all of this should fail, then there are topical lasers which may help. Insurance coverage for sclerotherapy depends on whether the insurer considers the procedure to be medically necessary. Eur J Vasc Endovasc Surg. The solution must be diluted as soon as possible. A member of your health care team cleans the area to be treated. A "mill wheel" murmur may be produced by movement of bubbles in the right ventricle. Sclerotherapy generally has few serious complications. Elsevier Inc; 2017;200-261. 2009;35(1):53-57. This treatment can be repeated three or four times at 5- to 15-minute intervals to maintain a systolic blood pressure >90 to 100 mm Hg, and it should be followed by establishing an intravenous line with a 0.9% sodium chloride solution. In vivo biological effects of foam sclerotherapy. If the hemosiderin persists, I have had good results treating the hemosiderin with low dose q-switched alexandrite lasers using multiple treatments spaced a month apart. Learn more about compression stockings for varicose veins here. Immediate intravenous application of acetylsalicylic acid, at a dosage similar to coronary events with an injection of 500 mg, might be beneficial, followed by 100 mg or 325 mg uncoated tablets of acetylsalicylic acid daily for the same period as the anticoagulation.22,24, Thrombolysis was used in four cases of inadvertent arterial injection. Anyone who experiences any chest pain, difficulty breathing, or dizziness after sclerotherapy should receive emergency medical care. Mowatt-Larssen E. Syncope for phlebologists. Thromboembolic complications of endovenous thermal ablation and foam sclerotherapy in the treatment of great saphenous vein insufficiency. Such coagulum, which is trapped between the two ends of a treated vein, tends to remain liquefied. Alternately, the doctor may administer an anesthetic and insert a catheter into the affected blood vessel, then use a solution of 90% alcohol to block the vein. Phlebology. There may be a mild burning sensation or cramping for a few minutes during the treatment of larger varicose veins. J Vasc Surg. Sclerotherapy is extremely safe and carries minimal risk of side effects. It can appear blue when covered by skin. 31. As ulcers may take 4 to 6 weeks to heal completely, even under ideal conditions, excision and occlusive dressing of these lesions are recommended at the earliest possible time, which gives the patient the fastest healing time, with decreased pain and an acceptable scar.6, Direct arterial/arteriolar injections are exceptionally rare.

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