[A paratibial fasciotomy technic in chronic venous insufficiency]

From extensive paratibial fasciectomies on account of crural ulcers W. Hach changed to subcutaneous fasciotomy from an incision 30 to 40 mm long with digital severing of the perforating veins. Its main effect is the creation of wide communication between the subfascial and suprafascial space. The subcutaneous tissue affected with lipodermatosclerosis rest on muscles well supplied with blood which can improve the trophics of surface tissues. The reduction of the surgical approach to 10 mm calls for special instruments. Instruments designed by the author proved useful. The author operated eight patients with advanced varicosis of the saphena maior with incompetence of two to three Cockett veins and with developed lipodermatosclerosis. After stripping of the saphena maior the smaller varicosities were extracted by dented strippers, haemostasis was ensured by tamponade by means of an applicator. Cockett's veins were interrupted in the subfascial layer from a paratibial incision in the middle of the leg by means of a 10 mm L-shaped chisel and straight chisel. This was followed by prolongation of fasciotomy by means of a fasciotome to the inner ankle. The postoperative course was devoid of complications with minimal pain, the cosmetic effect was excellent.