The
postphlebitic syndrome is a significant management problem that affects a large number of patients. Primary prophylaxis of deep-vein
thrombophlebitis would reduce the risk of developing the
postphlebitic syndrome and should be considered in high-risk patients. Patients who have had a
phlebitis should be monitored with noninvasive tests of the deep venous circulation for the development of venous valve incompetence. Patients with venous
hypertension should be placed in
compression stockings to prevent the
postphlebitic syndrome. In patients who progress to venous ulceration, several aggressive measures must be undertaken. Systemic treatment includes management of
obesity,
edema, immobility, poor nutrition, and comorbid illnesses. Some patients may require a short hospitalization of
bed rest, lower limb elevation, and daily dressings and
wound care. Outpatient
therapy requires sustained compression of 35 to 40 mmHg at the ankle for many months to allow the
ulcer to heal. The standard
bandage material is Unna's boots, which is applied every one to two weeks by a trained nurse. Cadexomer
iodide is an effective local treatment that helps debride the
ulcer and accelerate healing. Finally,
pentoxifylline therapy has also been shown to significantly improve the healing of
venous ulcers.