Surgical Treatment of Incompetent Perforator Veins by Subfascial Ligation

Abstract

Background: Chronic venous ulceration of the leg is a common presentation in surgical clinics. Although, the majority of ulcers can be healed by simple compression. Some chronic ulcers with venous competencies require correction surgeries. We in the current study tried to study the role of Cockett and Dodd's operation of subfascial ligation of below-knee perforator veins in the treatment of varicose veins of the lower limbs. Methods: This cross-sectional study was done in the Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. N=40cases of varicosities of the lower limbs with perforatorincompetence with or without saphenofemoral incompetence. The patients were treated with perforator ligationalone with the Cockett and Dodd method or in combination with the stripping procedure. Results: The clinical classification shows C5 healed venous ulcers and C6 active venous ulcers. 64% of cases belonged to these two categories and no case of C1 was found in our study. Perforator incompetence only was found in n=25 cases where perforator ligation alone was done given in table 4. In n=15 cases, perforator ligation and stripping with or without ligation of sphenopopliteal junction was done. The minimal mean duration of stay was 5.5 days the maximal mean duration of stay was 8.0 days. Conclusion: Open subfascial perforator ligation by Cockett and Dodd's procedure is a good procedure in the treatment of primary varicose veins with perforator incompetence. The rates of complications can be largely reduced by careful patient selection and skill full operative techniques. Follow-up of patients must be done at intervals for the development of new incompetent perforating veins and varicosities which may lead to the recurrence of ulcer formation.