Surgical correction of recurrent venous ulcer

Area of Science:

• Vascular Surgery
• Phlebology
• Venous Disease Management

Background:

• Recurrent venous leg ulcers often result from superficial and deep venous valve incompetence.
• Standard treatments for these ulcers can be ineffective, necessitating advanced surgical interventions.

Purpose of the Study:

• To evaluate the efficacy of different surgical techniques for correcting superficial and deep venous valve incompetence in treating recurrent venous leg ulcers.
• To compare the outcomes of combined superficial and deep venous system correction versus saphenous vein stripping alone.

Main Methods:

• Surgical correction was performed on 76 limbs from 46 patients with refractory venous ulcers.
• Procedures included saphenous vein stripping combined with perforator ligation, valvuloplasty, vein transposition, or valve transplantation.
• Follow-up ranged from 10 to 73 months (mean = 37 months).

Main Results:

• Healing rates varied: perforator ligation and stripping (44%), stripping plus valvuloplasty (80%), stripping plus transposition (78%), and stripping plus valve transplantation (75%).
• Combined superficial and deep venous system correction significantly outperformed saphenous vein stripping alone for patients with deep venous incompetence (p < 0.005).
• Perioperative use of compression stockings and pneumatic boots aided in swelling control and wound healing.

Conclusions:

• Surgical correction addressing both superficial and deep venous valvular incompetence offers superior outcomes for recurrent venous leg ulcers.
• Techniques involving saphenous vein stripping combined with deep venous valve repair (valvuloplasty, transposition, or transplantation) demonstrate high healing rates.
• Adjunctive compression therapy is beneficial in managing leg swelling and promoting ulcer healing post-surgery.