Clinical Evaluation of Operation for Intractable Leg Ulcer due to Primary Varicose Veins

Abstract

We studied 42 patients (23 males and 19 females with mean age of 45.8 and 57.9 years) with intractable leg ulcers due to primary varicose veins treated over the past 20 years (between 1980 and 1999) at our department. The mean duration from appearance of varicose veins and leg ulcer to operation in males and females were 10.6 and 12.7 years and 14.4 and 8.8 months, respectively. Among males leg ulcer tended to occur in the youth rather than in the elderly at multiple lesions. Most patients with leg ulcers worked in restaurants and retail stores regardless of gender. Solitary leg ulcers were seen in 32 cases and multiple ulcers in 10 (7 males and 3 females).

Small ulcers less than 2 cm in diameter were completely cured by stripping of great saphenous vein and excision of varices. As for ulcers more than 2 cm in diameter, we performed complete stripping and ligation of veins around ulcers. In addition, we ligated extrafascial or subfascial perforating branches in cases with incompetent valve. Furthermore, middle layer skin grafting was performed in nine cases, including recurrent ulcers and ulcers larger than 10 cm². All grafts completely adhered and no recurrences have occurred. Eight cases with recurrent ulcer were not diagnosed leg ulcer resulting from incompetent valves. Therefore it is important to detect an incompetent valve and ligate it to prevent the recurrence of leg ulcer.

Thus intractable leg ulcer could be healed completely by various operative techniques within a short period.