[Surgery of the perforating veins of the leg: open and endoscopic techniques]

Surgical treatment of incompetent perforating veins of the leg is best carried out through a sub-aponeurotic approach after localisation by coloured Duplex-Scanning. Open techniques are long established. When there is only one perforator, a short 5 cm approach is centred over the previously localised perforator. In the presence of multiple perforators, an extensive approach is necessary. This usually means a single long incision, situated para-tibially in the Linton approach, postero-medially in the Dodd approach or posteriorly in the Felder approach. The advantage of the last two approaches is that they are situated at a distance from any eventual cutaneous lesion. The approach can also be through several separate oblique incisions (De Palma). More recently introduced, endoscopic techniques have the advantage of reducing the incidence of cutaneous complications such as necrosis or infections and of shortening the duration of hospitalisation. Some authors work with re-usable instruments. The perforators are divided after coagulation (Hauer, Sattler). Others use disposable instruments, insufflate the sub-aponeurotic space and clip the perforators to prevent bleeding (Gloviczki). These techniques are currently undergoing evaluation.