title: Lateral Fasciectomy Sparing the Superficial Peroneal Nerve with Simultaneous Mesh Graft in Non-healing Lateral Leg Ulcers of Diverse Vascular Origins: Surgical Technique, Short- and Long-term Results from 44 Legs.
abstract: The technique of lateral fasciectomy (LF) sparing the superficial peroneal nerve with mesh graft coverage is a novel treatment of non-healing lateral leg ulcers of various vascular origin affecting the fascia. We report short- and long-term results of LF for recalcitrant lateral leg ulcers.
  
  
  
  This study is a single center, retrospective case series of consecutive patients treated by LF.
  
  
  
  From 827 ulcers treated at our institution, 44 recalcitrant lateral leg ulcers affecting the fascia (41 patients) underwent lateral fasciectomy between 2006 and 2013.
  
  
  
  Preoperative indications, step-by-step surgical procedures, and perioperative care methodologies are presented. Long-term effects of healing and recurrence were clinically investigated or obtained through telephone interviews with relatives and local practitioners.
  
  
  
  Three discrete etiologies were identified: venous ulcers (n = 24), arterial-venous/mixed ulcers (n = 11), and arteriolar Martorell hypertensive leg ulcers (n = 9). Complete healing was achieved in 40 legs (91%) after 3 months, and in 43 of the affected legs (98%) in total. The median duration to complete healing was 64 days. There was no difference between the healing times of different etiologies. No local recurrence was observed during the follow-up period, which ranged from 1.8 to 8.7 years (median: 5.11, mean: 5.12). Twelve patients (27%) died within this period due to multimorbidity.
  
  
  
  Following lateral fasciectomy and mesh graft coverage, 43 legs (98%) healed in previously treatment resistant lateral leg ulcers.
authors.affiliation: Department for Functional Phlebosurgery, Karl Landsteiner Society, Himmelreichstrasse 15, 3390 Melk, Austria; Department of Surgery, St. Josef Hospital of Vienna, Auhofstraße 189, 1130 Wien, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Obermayer
authors.affiliation: Department for Functional Phlebosurgery, Karl Landsteiner Society, Himmelreichstrasse 15, 3390 Melk, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Maier
authors.affiliation: Department of Surgery, St. Josef Hospital of Vienna, Auhofstraße 189, 1130 Wien, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Zacherl
authors.affiliation: Research Office (Biostatistics), Paracelsus Medical University, Strubergasse 20, 5020 Salzburg, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Hitzl
authors.affiliation: Department for Functional Phlebosurgery, Karl Landsteiner Society, Himmelreichstrasse 15, 3390 Melk, Austria; Department of Surgery and Vascular Surgery, University Hospital St. Poelten, Propst-Fuehrer-Strasse 4, 3100 St. Poelten, Austria. Electronic address: ferdinand.steinbacher@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Steinbacher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071938:Fasciotomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D010543:Peroneal Nerve / Q000601:surgery*; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000601:surgery*
keywords: Fasciectomy; Lateral; Martorell; Nerve sparing; Superficial peroneal nerve; Ulcer