Post-thrombotic leg ulcer and its surgical treatment
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A novel surgical approach effectively treats post-thrombotic syndrome by addressing venous, arteriovenous, and lymphatic factors, achieving a remarkable 0.5% recurrence rate for chronic leg ulcers.
Area of Science:
- Vascular Surgery
- Dermatology
- Venous Disease
Background:
- Post-thrombotic syndrome (PTS) is a chronic condition following deep vein thrombosis.
- PTS development involves venous valvular incompetence, arteriovenous shunts, and lymphatic dysfunction.
- Chronic leg ulcers are a debilitating manifestation of severe PTS.
Purpose of the Study:
- To evaluate a comprehensive surgical strategy for managing chronic post-thrombic leg ulcers.
- To assess the efficacy of a multi-faceted surgical approach targeting key PTS etiological factors.
- To determine the recurrence rate of chronic post-thrombic leg ulcers after this specific surgical intervention.
Main Methods:
- Surgical intervention included saphenous vein stripping, wide excision of ulcerated areas with fascia and immediate skin grafting, and extensive subcutaneous tissue and fascia excision.
- The surgical technique aimed to address venous valvular incompetence, arteriovenous shunts, and lymphatic disturbances.
- Fifty-one patients with chronic post-thrombic leg ulcers underwent this surgical procedure.
Main Results:
- A single patient experienced recurrence, resulting in a very low recurrence rate of 0.5%.
- This outcome demonstrates high efficacy in preventing ulcer recurrence post-surgery.
- The surgical approach proved highly successful in managing complex chronic post-thrombic leg ulcers.
Conclusions:
- The described surgical treatment effectively addresses the multifactorial nature of post-thrombotic syndrome.
- This comprehensive surgical strategy offers a favorable and durable solution for chronic post-thrombic leg ulcers.
- The low recurrence rate suggests this approach is superior to other published methods for PTS ulcer management.
Abstract:
The post-thrombotic syndrome is a complex disease to whose development at least three factors contribute: (1) incompetence of the venous valvular system; (2) opening of the local arteriovenous shunts; and (3) disturbances in the lymphatic system. Our surgical treatment considers all three factors by providing: (1) stripping of the saphenous veins; (2) wide excision of the ulcerated region with the fascia, followed by immediate skin graft; and (3) large excision of subcutaneous tissue and fascia. Of fifty-one patients with chronic post-thrombic leg ulcers operated on according to these principles, only one had recurrence, a recurrence rate of only 0.5%. This compares favorably with other published results.