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. |
