Follow-up Question: Healing? Do I need surgery after complications from Sclerotherapy? (photos)

Post sclerotherapy ulceration is a rare complication of sclerotherapy but is much more common with hypertonic saline than with other newer sclerosants like Polidocanol and STS. Polidocanol is also less likely to result in hyperpigmentation compared to STS and so for most patients that is the best choice to minimize complications and yield good results. The picture shows skin necrosis that appears to be full thickness and so debridement of the dead tissue and appropriate wound care should result in faster healing.  Once fully healed, if the scar is cosmetically unpleasing, an excision of the scar could be accomplished surgically.  For any future sclerotherapy, I recommend you find a Vein Specialist and specifically request Polidocanol.

Unfortunately, some sclerosants cause skin necrosis.Next time, instead of choosing hypertonic saline, choose Polidochanol or STS. The likelihood of skin necrosis is very very small with these FDA approved chemicals. You need to use some adjunctive measures after sclerotherapy to reduce post inflammatory hyperpigmentation. it is those that don't follow such instructions immediately following sclerotherapy, starting on day1 (next day) that seem to get retained hyperpigmentation. I recommend 2 creams: Scleroquin plus and Sclerovase and also Scler-X supplement to reduce post inflammatory hyperpigmentation (see link below) as well as compression stockings for at least 2 weeks.
H Karamanoukian MD FCS
certified vein specialist from ABVLM and double board certified surgeon
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Unfortunately, from the photo you have complete breakdown of the protective skin layer.  This needs to be treated with debridement and follow up wound care or even further surgery.  I suggest seeing a wound care specialist or a plastic surgeon to care for it.  I don't believe waiting will serve you well.  

A skin ulcer or wound is a rare complication of spider vein sclerotherapy. This complication may occur with even the most experienced spider vein treatment physician.
It is best to keep the wound clean and dry and to be VERY patient as the ulcer usually takes months to heal. It is impossible to know what the ultimate cosmetic result will be until given a chance to heal. The cosmetic outcome may not be nearly as bad as the appearance of the healing ulcer.
However, most healed skin ulcers will leave a scar that can be more disfiguring than the spider vein that was treated.
The best cosmetic treatment, after given a chance to heal, and if the scar is cosmetically disturbing, is simple excision of the scar. An experienced plastic surgeon can easily perform the excision.

I would recommend excision of the dead tissue to healthy tissue followed by a topical would care agent.  This would expedite the healing time.

Your photo suggests a full thickness skin necrosis which would heal faster if the dead black tissues were surgically debrided and proper dressing changes were instituted. These should heal on their own after that but will leave scars.