Diagnosis and Treatment of Chronic Leg Ulcers

To the Editor:—  The Chairman's Address, "Chronic Leg Ulcers" (JAMA186:1080 [Dec 21] 1963), emphasizes the many facets and problems coming under this title. However, several procedures in diagnosis and treatment have not been emphasized in this review or in recent symposia and deserve comment because of the decreased hospitalization time and improved results which can be accomplished when they are used.As part of the evaluation of venous incompetency ulcers, injection of 25 to 30 ml of radiopaque dye in a foot vein with the patient in the upright position will allow much more accurate localization of the incompetent perforating veins than will physical examination alone. On completion of the injection an anteroposterior film is taken, after which the dye will remain pooled for about 15 seconds. This is sufficient time for a lateral exposure, thus obviating the need for automatic film-changing equipment, biplane machines, or multiple injections.