A clinical and haemodynamic investigation into the role of calf perforating vein surgery in patients with venous ulceration and deep venous incompetence.
OBJECTIVE
To determine the clinical efficacy and local haemodynamic effects of perforating vein surgery in ulcerated limbs with combined deep and perforating vein incompetence.


METHODS
Prospective, interventional study.


METHODS
Seven ulcerated limbs with combined primary deep and perforating vein incompetence were studied. Clinical efficacy was determined by ultimate ulcer healing and reduction in ulcer area, local haemodynamics were assessed at three sites with photoplethysmographic 90% venous refilling times (PPG RT90); both assessments were performed pre- and 1-month postoperatively.


RESULTS
None of the ulcers healed following perforating vein surgery, the median (range) ulcer areas pre- and postoperatively were 31 (7-685) cm2 and 35.5 (7-796) cm2 (Wilcoxon p = 0.07). Preoperative PPG RT90 demonstrated a global abnormality of venous function at all sites examined that persisted after perforating vein surgery.


CONCLUSIONS
In the presence of deep venous incompetence perforating vein surgery had no influence on venous function or ulcer healing. We conclude that perforating vein surgery is not indicated for the treatment of venous ulceration in limbs with primary deep venous incompetence.
Scriven
J M
JM
Department of Surgery, University of Leicester, U.K.
Bianchi
V
V
Hartshorne
T
T
Bell
P R
PR
Naylor
A R
AR
London
N J
NJ
D000368:Aged; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D017156:Photoplethysmography; D012039:Regional Blood Flow / Q000502:physiology; D012501:Saphenous Vein / Q000601:surgery; D018615:Ultrasonography, Doppler, Color; D014647:Varicose Ulcer / Q000503:physiopathology / Q000601:surgery*; D014689:Venous Insufficiency / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology