PERFORATORS COMPARISON BETWEEN OPEN AND ENDOSCOPIC SUBFASCIAL LIGATION OF INCOMPETENT LEG

Abstract

Chronic venous insufficiency with venous stasis ulcyration is a common and debilitating disease (Sato et a!., 1999). The management of ulceration associated with chronic venous insufficiency remains difficult, frustrating and associated with high failure rates (Kistner et al., 1995). Venous ulcers are almost always situated in the lower part of the leg. The venous drainage of this area was proved to pass directly to deep veins tlrrough a number of short perforating veins. They are usually three and are connected to each other (Dodd <111d Cockett, 1976).

Linton proposed that those patients with perforator incompetence could be treated by dividing the offending perforators. Unfortunately, in order to achieve this goal, a long incision tlrrough the unhealthy medial skin from the knee to the medial malleolus was necessary. Perforators could then be identified below the fascia and divided (Kulbaski et a!., I 997). In concept, the procedure was sound. On average, 85% of patients enjoyed ulcer-free leg in the long-term. However, .wonnd related complications such as infection, flap necrosis and delayed healing occurred in I 7% of patients and caused the procedure to fall into disfavor (Sahary and Scurr, 1996). Although several modifications of Linton's procedure have been developed to minimize wound morbidity such as the posterior stocking seam incision and parallel oblique incision, it was not nntil the development of minimally invasive procedures, which peri-hitted small remote incisions to be created, that the procedure began to be re-evaluated (Kulbaski et a!., 1997).