Efficacy of subfascial endoscopy in eradicating perforating veins of the lower leg and its relation with venous ulcer healing.
ABSTRACT The purpose of this study was to investigate the efficacy of subfascial endoscopy by use of a mediastinoscope in the identification and ligation of incompetent perforating veins in patients with venous ulceration of the lower leg.
All patients who underwent subfascial endoscopy for venous ulceration between Jan. 1, 1994, and Mar. 1, 1995, at the Sint Franciscus Gasthuis in Rotterdam underwent duplex ultrasound scans of the lower leg before and 6 weeks after operation. The number and localization of the perforating veins on the mediodorsal side were compared with the findings during subfascial endoscopy.
In 20 patients, preoperative duplex examination showed 46 incompetent and six competent perforating veins. During operation the site of 43 incompetent and all competent perforating veins was confirmed. Five additional perforating veins were found at operation (false-negatives). Postoperative duplex ultrasound scans showed six incompetent perforating veins (four persisting and two recurring perforating veins) in four patients, of which the ulcers did not heal in three. The ulcers of the other 17 patients healed.
Subfascial endoscopy is an efficient technique in identifying incompetent perforating veins in patients with chronic ulceration of the lower leg. The persistence of incompetent perforating veins is related to failure of ulcer healing.
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ABSTRACT: Managing venous leg ulcers involves management techniques that are indicated both in the treatment of all chronic leg ulcers and those that are specific to venous leg ulcers. The first step in managing venous leg ulcers is performing a holistic assessment of the patient. Once this is complete, any systemic or local factors that may affect wound healing should be addressed. This approach to managing the whole patient is critically important because if significant general wound healing factors are not treated, other specific attempts at healing the venous ulcer will be fruitless. This paper reviews nutritional supplementation, wound bed preparation, antimicrobial therapy, venous insufficiency, compression therapy, different bandage systems, therapeutic adjuncts to compression therapy, and recent advances in vascular surgery. Recurrence prevention also is discussed.Ostomy/wound management 07/2001; 47(6):36-42, 44-9. · 1.08 Impact Factor
Article: Surgical removal of ulcer and lipodermatosclerosis followed by split-skin grafting (shave therapy) yields good long-term results in "non-healing" venous leg ulcers.[show abstract] [hide abstract]
ABSTRACT: The purpose of this study was to evaluate the long-term effects of shave therapy in non-healing venous leg ulcers. Forty-one patients with 75 recalcitrant leg ulcers caused by primary deep vein incompetence or post-thrombotic syndrome were operated by shave therapy (removal of ulcer and surrounding lipodermatosclerosis with a Schink skin-grafting knife and covering of the wounds with meshed split-thickness skin grafts). After an average follow-up period of 2 years and 5 months all patients were evaluated for long-term results. The healing rate of ulcers classified as non-healing was 67% (50 of 75 ulcers). The healing rate was 76% for ulcers associated with primary deep vein incompetence and 58% for ulcers associated with post-thrombotic syndrome (p = 0.08). Even in cases with recurrence (33%) these ulcers were strikingly reduced by 80-90% of their original size. Hypaesthesia was noticed in 38% of the transplanted areas. In "non-healing" venous leg ulcers due to deep venous insufficiency shave therapy yields favourable long-term results. Because it is only a symptomatic treatment which does not reduce the pathological refluxes, continuous compression of the lower leg is important.Acta Dermato Venereologica 80(4):267-71. · 3.18 Impact Factor