Endoscopic Subfascial Perforator Interruption And It's Role In Varicose Ulcer Healing.
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Perforator incompetence is seen in nearly 60% of patients with ulceration usually in combination with superficial or deep system abnormalities. Detailed duplex sonographic examination of the entire lower limb venous system in patients with ulceration can clearly identify patterns of venom abnormalities. This study was designed to apply the technique of endoscopic subfascail perforator interruption (ESPI) to our patients with venom leg ulcers and to study it's effect in relation to ulcer healing. It included 14 patients with active. (11 cases) or healed (3 ernes) venous leg ulcers. Nine were males and five were females. Their age ranged between (34-52) years with a mean of (43.1 + 5.4 years). All patients underwent color-flow Duplex ultrasound scanning on their leg veins pre-operatively and two weeks after the operation. The procedure of ESPI was done to all patients, ming the standard laparoscopic instruments with carbon-dioxide insufflation. Ancillary surgical procedures for superficial venous system abnormalities were done in the same sitting according to the clinical and color-flow duplex findings. Follow up plan was at two weeks interval for the 1" month and then monthly for six months. Excellent results (E) were achieved in 8 patients with complete ulcer healing in 2 months, improved results (I) occurred in 5 patients with ulcer healing in 3 months postoperatively but with mild oedema and eczema. In one patient, there was an initial improvement in ulcer, but recurred again (R) and failed to heal over the six months follow up. Complications ofthe procedure were negligible. It was concluded that endoscopic subfascial perforator interruption seems to be a safe technique with minimal complications and favorable early results regarding venom ulcer healing. Eradication of IPVs and simultaneous surgical correction of superficial venous system abnormalities seem necessary to have excellent results regarding ulcer healing.