Surgical Treatment of Refractory Venous Stasis Ulcer Due to a Severe Impairment of Calf Muscle Pump Function: Evaluation by Air Plethysmography

Abstract

The authors encountered a forty-nine-year-old man with a lower limb ulcer refractory to intensive conservative therapy. No varicose vein was found anywhere, and the usual phlebographies and foot venous pressure measurement failed to diagnose it as a venous stasis ulcer. A direct phlebography method developed by the authors, in which a thin catheter is inserted into the deep vein, disclosed a reflux of the popliteal vein or a deep muscle branch from which an incompetent perforator arose toward the superficial vein above the ulcer. Air plethysmography (APG) showed a severe impairment of the calf muscle pump function. He underwent a subfascial ligation of two incompetent perfora tors together with a stripping of the great saphenous vein passing under the ulcer. Postoperatively, this ulcer was cured in an early phase, and the calf muscle pump function showed improvement in the APG.