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February 1991

Four-Layer Bandaging: An Effective Treatment for Lower Limb Ulceration Associated With Arteriovenous Malformation

Author Affiliations

Department of Dermatology Royal Hallamshire Hospital Glossop Road Sheffield S10 2JF, England

Arch Dermatol. 1991;127(2):274-276. doi:10.1001/archderm.1991.01680020146034

To the Editor.—  We describe a patient with intractable pain and ulceration of the foot associated with an arteriovenous malformation. Conventional dressing techniques failed, and the possibility of amputation was under consideration when healing was achieved using the recently reported technique of four-layer bandaging.1

Report of a Case.—  A 35-year-old previously healthy Bangladeshi woman presented with a 12-month history of painful ulceration over the dorsum of the right foot (Fig 1). Her health was otherwise good. Dilated veins on the dorsum of the foot and a bruit at the ankle suggested a possible underlying arteriovenous malformation. Angiographic studies confirmed this, demonstrating an extensive arteriovenous malformation in the forefoot fed by grossly dilated anterior and posterior tibial arteries (Fig 2). Treatment with various compressive bandages applied regularly over an 8-month period and culminating in a 4-week period of hospitalization, produced no improvement. Complete healing was achieved, however, within 3 weeks

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