It is extremely rare to find the varicose veins in the arms. Usually it is a disease of the lower limbs. However, it is not unknown to have venous problems in the upper limbs. These may be a result of venous thrombosis or primary disease of the veins. The venous thrombosis can be detected by a venous duplex scan. This will show the old thrombosis as well as the new problem. The duplex will also show the presence of venous malformation. It is possible an angiogramme may need to be done to further define the vessels and also to check if the disease is restricted to the veins only or the arteries are involved as well. I am bit suspicious if the diagnosis of the varicose veins is correct as the condition of varicose veins is not usually a fulminant disease that; a) it would be so bad at the age of 23 and b) that it would advance to the stage of ulcer in a short span of 4 years. My personal view is that we have to keep in mind other causes of the skin ulcers, namely vasculitis or other connective tissue disorder. The other suggestion would be to check the arterial supply of the limb along with the taking a biopsy of the ulcers to see the histology of the ulcers. It after all this information is evaluated that treatment of the condition can be effectively done.