A new technique for chronic venous ulcers of the lower limb: modified Felder-Rob procedure

Subfascial ligation of perforating veins is a commonly performed operative procedure for chronic venous ulcers of the leg. The most widely adopted incision currently used is the posterior midline approach described by Felder. This, however, is associated with significant morbidity due to necrosis of skin overlying the tendo Achillis with consequent exposure-induced necrosis and contracture of the tendon. A new incision based on anatomical studies is described. The procedure was adopted in 45 limbs with chronic venous ulcers. The incision is associated with very minimal morbidity and has given excellent results in the form of a major necrosis rate of only 4.4% (none of which involved the skin over the tendo Achillis or the tendon itself) and an ulcer recurrence rate of 4.4% during the period of follow-up of 2-8 years.