A 64-year-old woman presents with wounds to her left ankle. Although her soft-tissue cultures and arterial Doppler and duplex studies were unremarkable, her venous reflux studies showed right and left small saphenous vein insufficiency. After 8 weeks of standard treatment, her wounds to the left ankle did not improve, and she developed a wound to her right anterior leg. Her left ankle wound healed 8 months after initial presentation, and her right leg wound healed in 3 months. Thereafter she underwent an endovenous ablation of her left small saphenous vein, without apparent complications. Two weeks after surgery, she developed an incision site scab that worsened and ulcerated. This case report highlights pathergy from endovenous ablation for lower-extremity venous disease.