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 venous
abnormalities. This study was designed to apply the technique of endoscopic
subfascait perforator interruption (ESP) to our patients with venous
leg ulcers and to study it's effect in relation to ulcer healing. It included
14 patients with active (11 cases) or healed (3 cases) 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 preoperatively
and six weeks after the operation.The procedure of ESPI was
done to all patients using the standard laparoscopic instruments with
carbon-dioxide insufflation. Ancillary surgical procedures for superf icial
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 Pt" 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 post-operatively but with mild oedema and eczema In one patient,
there was an initial improvement in ulcer but recurred again (IR)
and failed to heal over the six months follow up. CoMP lications of the procedure
were negligible. It was concluded that endoscopic subfascial |
