[General surgeon's approach to deep phlebitis of the leg]

The therapeutic problems of the general surgeon, faced with a case of deep phlebitis of the lower limbs, differ according to whether it is diagnosed before or after surgery. If possible, pre-surgical phlebitis should be treated before the operation. Heparinotherapy remains the basic treatment. But there are numerous arguments against, or for the modification of, its use : old age, haemorrhagic lesions, haemorrhagic risks during surgery, or simply great operational urgency. In all these cases, an elastic bandage is invaluable. Treatment of post-operative phlebitis is also based on the heparins, combined if necessary with antibiotics and corticoids, but these products can result in iatrogenic complications (ulcers, haemorrhage). It is often difficult to choose between embolic and haemorrhagic risks ; it is always easy to apply an elastic bandage which suffices in most cases to remove the inflammatory signs of the phlebitis. This problem is not so frequent since systematic prevention has made post-operative phlebitis more rare. The use of anticoagulants in vascular surgery seems to the authors to be not so much an effective therapeutic method as a method to be feaved close surveillance of coagulation is indispensable during treatment.