SAPHENOFEMORAL LIGATION AS A SAFE AND EFFECTIVE ALTERNATIVE FOR TREATMENT OF CHRONIC VENOUS LEG ULCER
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This study was designed to evaluate the effectiveness and safety of isolated saphenofemoral junction ligation for the treatment of chronic venous leg ulcer in comparison to traditional stripping procedure and comprised 36 patients, (28 men and 8 women) with mean age of 42.3±8.7. After full history taking, patients were examined for venous diseases, presence of edema, cellulitis or local ulcer infection. Site and size of ulceration was recorded, and ankle: brachial pressure index (ABPI) was measure and considered to be abnormal if<0.9. Venous color doppler ultrasonographic examination was performed and venous valvular incompetence was assessed using Valsalva test and calf compression, then patients were divided into two groups according to the surgical maneuver: stripping group, (n=10) assigned to undergo long saphenous stripping under general anesthesia using Trendlenburg maneuver combined with ligation of major tributaries and saphenofemoral ligation (SFL) group, (n=26) assigned to undergo saphenofemoral ligation ( SFL ) and excision combined with ligation of major tributaries under local infiltration anesthesia. Mean duration of surgery, postoperative morbidity, complications and duration of hospital stay were recorded. Patients received a compression stocking, and were examined monthly for 3 months then every three months till ulcer healing or for 12 months. Duration of surgery and period of postoperative hospital stay were significantly (P<0.05) reduced in SFL group compared to stripping group. Also, postoperative morbidity and complications were significantly (X2= 7.5, P<0.05) reduced in SFL group. Both modality of management succeeded to induce ulcer healing started after 3 months in SFL and 6 months in stripping groups, but, by 12 months, .SFL resulted in significant, (X2= 6.7, P<0.05) number of healed ulcer (n=22, 84.6%), compared to stripping procedure, (n=7, 70%). Moreover, there was a progressive decrease of the ulcer size throughout the follow-up period, in both groups but started earlier in SFL group. We can conclude that isolated ligation of saphenofemoral junction is a minimally invasive, safe and effective modality for treatment of chronic leg ulcer with results superceding the traditional stripping procedure, and being easily performed under local infiltration anesthesia it is a satisfactory procedure for treatment of leg ulcer in patients unfit for general anesthesia.