Hi Veronica, Thanks for your question.

With limited information on the treatment history, and etiology of the wound, I will make some recommendations primarily based on the photos you sent. The etiology looks to be venous reflux and associated hypertension. There is edema, hemosiderosis, and superficial varicosities present on both legs. Is the patient in compression? and at what level are you using if using this modality? If using, is the patient compliant with this? If not, what other interventions for venous disease have you pursued? Has the patient had a venous vascular reflux study? If not this should be done and recommendations for venous vascular ablation could be pursued if warranted. I would also have the technicians look for perforating veins connecting the deep and superficial systems at the level of the wound. If this is identified, it could be ablated as well. Other recommendations would center around reducing edema, including diuretics, elevation, compression pumps, manual lymphedema therapy, etc.

I hope this helps