Surgical anatomy for subfascial endoscopic perforating vein surgery of laterally located perforating veins.
OBJECTIVE
Endoscopic ligation of perforating veins is useful in treatment of perforating vein incompetence. Over the last few years the topic of interest has been the medial side of the lower leg; however, laterally located venous ulcers (10% of all) are of equal importance. Our poor results with lateral subfascial endoscopic perforating vein surgery (SEPS) procedures led us to study the anatomy of the perforating veins in the lateral leg. The presence of persistent insufficient perforating veins in our patients suggests that our procedure failed because of misinterpreted perforator anatomy.


RESULTS
Anatomic dissection was performed in 16 cadavers in two stages, subcutaneously and subfascially. Perforating veins were classified relative to the short saphenous vein and intermuscular septa, with coordinates. Three hundred fifty-one perforating veins were found, for an average of 21.9 perforating veins per leg. The results showed that there is alignment of the perforating veins according to the septa between the anterior and peroneal compartment and between the peroneal compartment and the superficial dorsal compartment. Most of the perforating veins did not correlate with the short saphenous vein.


CONCLUSIONS
Poor clinical results of lateral SEPS procedures might be improved after adjustment of the procedure for new anatomic information, which shows alignment of perforating veins along the intermuscular septa, obligating full septa dissection on the lateral side.
de Rijcke
Piet A R
PA
Department of Vascular Surgery, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands. pderijcke@yahoo.com
Schenk
Tejo
T
van Gent
Wijnand B
WB
Kleinrensink
Gert-Jan
GJ
Wittens
Cees H A
CH
D004210:Dissection; D004724:Endoscopy; D005205:Fascia / Q000033:anatomy & histology*; D006801:Humans; D007866:Leg / Q000033:anatomy & histology / Q000098:blood supply*; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000098:blood supply; D014680:Veins / Q000033:anatomy & histology* / Q000601:surgery*