Sympathectomy in the treatment of chronic venous leg ulcers

Patients with recurrent, intractable postphlebitic ulcer were treated by using sympathectomy as an adjunctive procedure. After standardized aggressive conservative therapy and 47 prior operations, including skin grafts, local excision, and various localized and extensive vein ligations and/or strippings, 23 patients continued to have ulcerations for 11 months to thirteen years. After sympathectomy, all ulcers healed within two to 6 1/2 months. During a follow-up of 2 1/2 to 11 years, 18 patients remained free of ulcers. Four had recurrent ulcerations, three promptly healing with reinstitution of elastic support, which had been discontinued. Sympathectomy is a simple and effective adjunctive method of surgical management for the occasional patient with intractable recurrent postphlebitis ulceration.