Subfascial endoscopic perforator surgery with tumescent local anesthesia.
BACKGROUND
Subfascial endoscopic perforator surgery (SEPS) has become an established procedure.


OBJECTIVE
To evaluate SEPS with tumescent local anesthesia (TLA) using an single-port device originally designed for that purpose.


METHODS
Patients selected for SEPS received subcutaneous infiltration of TLA into the medial aspect of the calf 20 minutes before surgery. Bipolar coagulation and dissection were used to treat incompetent perforators.


RESULTS
Fifty-one patients with 67 legs of CEAP stages C3-C6 underwent SEPS with TLA. In 40 patients or 53 legs (79.1%) TLA alone allowed successful completion of the SEPS procedure. Five patients with 7 legs (10.4%) required additional intravenous analgesics during surgery. In 4 patients or 4 legs (6.0%) with marked dermatoliposclerosis, pain control with TLA was so inadequate that SEPS had to be stopped.


CONCLUSIONS
SEPS with TLA is feasible in patients with CEAP stage C3-C6. However, patients with pronounced dermatoliposclerosis are likely to need more invasive analgesic measures.
Proebstle
T M
TM
Department of Dermatology, University of Mainz, Mainz, Germany, and Rosenpark-Klinik, Darmstadt, Germany.
Bethge
S
S
Barnstedt
S
S
Kargl
A
A
Knop
J
J
Sattler
G
G
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D016292:Procedural Sedation; D019723:Endoscopes; D004867:Equipment Design; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D014689:Venous Insufficiency / Q000601:surgery*