Not Just a Dog Bite: Unmasking Underlying Chronic Venous Insufficiency

Abstract

An 81-year-old man sustained a dog bite to his right lateral calf. Despite antibiotics, the patient continued to have leg swelling, severe itching, and a chronic wound. He was evaluated at the Wound Center, at which time a diagnosis of chronic venous insufficiency was made, and a venous reflux examination was recommended. The patient was scanned using Intersocietal Accreditation Commission Vascular Testing venous reflux protocol. Imaging was directed to the area of concern at the lateral calf. A 1.1-mm vein branch off the proximal calf great saphenous vein (GSV) was identified under the itching/trauma area with venous reflux identified. Venous reflux examination findings identified significant venous reflux from the right saphenofemoral junction through the distal calf GSV and vein branches. An elective right GSV endothermal venous ablation and stab phlebectomy were performed. The patient returned per protocol on postoperative day 2. He reported no pain and complete resolution of itching. Physical examination demonstrated marked improvement in the excoriated area. Surveillance duplex revealed no evidence of an endovenous heat-induced thrombosis. Venous stasis dermatitis occurs when there is inflammation of the skin caused by chronic venous insufficiency. In the early stages, symptoms include swelling at the ankles, hyperpigmentation, dryness, and itching. The development of stasis dermatitis can be precipitated by trauma, thereby unmasking underlying chronic venous insufficiency. Stasis dermatitis in this patient resolved because we treated the cause: chronic venous insufficiency.