[Resurgence of vein perforation surgery: SEPS (subfacial endoscopic perforator surgery)]

The treatment of venous ulcers is a challenge even in this era of modern medicine. The role of incompetent perforating veins in the pathophysiology of venous ulcers has been well documented. Open surgical interruption of incompetent perforating veins (Linton's procedure) may be complicated by important wound healing problems, and has never gained widespread acceptance as a first choice treatment. Recently, an endoscopic technique of subfascial interruption of perforating veins has been developed. This new procedure, with smaller scars and faster recovery, gives promising midterm results. The authors summarize their initial experience with subfascial endoscopic perforating surgery (SEPS) during the last three years (25 cases). They obtained ulcer healing in all cases. At 16 month follow-up, 88% of patients remain ulcer free. Three patients developed a new minor ulceration in the era of lipodermatosclerosis. This less invasive technique is a promising tool in the management of patients with venous ulcer disease.