Experience with subfascial ligation for varicose veins in Tanzania: a brief communication

From January 1987 through December 1989, ten patients with varicose veins complicated by postphlebitic ulcers were treated at Muhimbili Medical Center, Tanzania, by subfascial ligation of perforating veins. The technique employed was a posterior subfascial approach which avoids making the skin incision through the ulcer itself. The follow up periods ranged from one to three years and there was no recurrence of the ulcer in any of the patients in the study. The major indication for performing the procedure was the presence of a varicose stasis ulcer. Before surgery, all patients had a complete peripheral vascular examination to exclude deep venous thrombosis. Healing of varicose ulcers and elimination of stasis eczema had to be achieved four weeks before surgery. The authors maintain that patients who present with varicose veins of the lower leg and a postphlebitic stasis ulceration invariably have incompetence of the valves in the perforating veins and should be treated by subfascial ligation of the perforating veins.