Surgical Treatment of Stasis Venous Ulcers of the Lower Limb

Abstract

Ten patients with severe lower extremity stasis venous ulcer refractory to medical therapy were selected to undergo excision of the ulcer and the underly ing muscle fascia and interruption of the incompetent communicating veins with split thickness skin grafting. All patients had evidence of lipodermatosclerosis. Eight patients had a descending venogram that showed grade IV regurgitation and 2 had an ascending venogram that showed patency of the venous system. All patients had venographic evidence of incompetent communicating veins. Biopsies obtained from calf muscle (4) and sural nerve (2) were consistent with neuromyopathy. Thermodilution study performed in 4 patients showed in creased flow to the affected limb with pooling of venous blood. Follow-up (mean thirteen months) showed healing of all ulcers and no ulcer recurrence. The authors suggest that this procedure be reserved for patients with gross and permanent pathologic changes in and around the ulcer when medical therapy fails.