The reader’s question is: A reader from Rizhao, 59 years old, female, has varicose veins in her legs, which are not too serious. Last year, a car accident caused a fracture in the scapular area, and her leg was swollen but not broken. After a long hospital stay, the varicose veins turned into venous thrombosis. The prominent symptom is that the skin on my ankle is often ulcerated and itchy. What should I do? What do I need to pay attention to in general? Also, should I pay attention to this thrombosis and do I need to take any measures when I recover from the surgery this year to remove the steel plate? Answer: Hello, this condition is caused by post-deep vein thrombosis syndrome (abbreviated as DVTS or PTS). Normally, human blood is transported from the veins back to the heart and pumped through the heart into the lungs for gas exchange. The return of blood to the legs depends on the veins, which consist of deep veins and superficial veins, with the deep veins being the main channels of blood return. The superficial veins include the greater saphenous vein on the inside of the leg and the lesser saphenous vein on the outside, which collect blood from the superficial tissues of the leg and converge into the deep veins. These leg veins have many valves, similar to valves, that allow blood to flow only in one direction toward the heart. Especially when humans stand up, the role of these valves is more important as they counter the gravity of the blood and prevent the occurrence of pathological conditions such as varicose veins. The occurrence of varicose veins is highly related to the function of the venous valves. If these valves, especially the superficial ones, do not close properly, there is a regurgitation of blood, similar to a backflow, and a stagnation of venous blood in the legs. The walls of the veins are thin, and the accumulation of blood will lead to venous dilation, which in turn will aggravate the degree of poor closure of the valves, and the venous dilation will continue to increase, resulting in varicose veins, which is a vicious circle that will lead to more and more severe varicose veins. Deep vein thrombosis has a great relationship with varicose veins. In the case of varicose veins, venous blood stagnates in the legs, blood return is slow, and with bed rest after trauma, blood stagnation, and trauma may directly injure the blood vessels, it is easy to form deep vein thrombosis. Deep vein thrombosis in the acute stage is manifested by sudden thick swelling and pain in the affected limb, and even the thrombus may be dislodged and returned to the heart with the venous blood and pumped into the pulmonary artery, leading to pulmonary embolism. Severe pulmonary embolism may even lead to sudden death and endanger our lives. This acute phase is 2 weeks if treated with standard treatment. Post deep vein thrombosis syndrome (DVTS or PTS) is the most common complication after deep vein thrombosis (abbreviated as DVT). Typical symptoms include pain, swelling, swelling, cramping, and itching in the affected limb, either alone or in combination, intermittent or persistent, usually worse with standing or prolonged walking, and lessened with rest or elevation of the affected limb. PTS can be characterized by edema of the extremity, capillary dilation in the ankle or greater, skin pigmentation in the boot area, stasis dermatitis, and in severe cases, chronic, untreated venous ulcers. In addition, secondary varicose veins may also occur. Like you, deep vein thrombosis occurred after last year’s trauma, and since then, without standardized treatment, the veins of the entire leg have accumulated in the diseased leg, resulting in venous ulcers and stasis dermatitis, which is typical of post-deep vein thrombosis syndrome. This condition will not heal on its own, but will only get heavier and heavier, and the ruptured surface will get bigger and bigger, which is commonly known as “old rotten leg”. What should be done in this case? In daily life, when resting, pay attention to elevate the affected limb, usually about 20-30 degrees above the level of the heart. It is recommended to wear medical grade elastic stockings when moving down to the ground. Appropriate walking can promote muscle contraction. You can also take oral medications to improve the function of the veins, such as Diosmin, Myclobutanil, and Trigonelline Coumadin tablets, to improve the symptoms of heavy and uncomfortable legs. Generally, it is also necessary to review the ultrasound of the veins of the lower extremities to identify the site of the lesion. If the blocked vein is above the root of the thigh, an interventional minimally invasive procedure may be considered to open the diseased vein and facilitate the return of blood to the vein in the diseased leg. If the leg is ruptured and does not heal over time, a review of the lower extremity vein ultrasound is needed. In addition to the blockage of the deep vein and the obstruction of blood return, the opening of the penetrating vein is also an important cause of the rupture. Under normal circumstances, the penetrating vein returns blood directly to the deep vein, and the penetrating vein also has a valve that allows blood to flow only in one direction medially. However, in patients with post-deep vein thrombosis syndrome, venous hypertension can lead to poor closure of the valves in the penetrating veins, increased local pooling of blood, which can affect the nutritional status of the skin and fat, and skin breakdown. These lesions in the penetrating veins need to be treated surgically in time, otherwise the “old rotten leg” will not heal. When reoperating, certain measures need to be taken to avoid recurrence of deep vein thrombosis. It is generally recommended to drink more water after surgery, to get out of bed as soon as possible, to avoid prolonged fixation in one position in bed, and to take measures such as circulatory drive and low molecular heparin to significantly reduce the risk of recurrence.