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. |
