2006 Volume 17 Issue 5 Pages 287-291
The accurate diagnosis and selection of surgical indication are very important for the treatment of venous ulcers. A 63-year-old woman was admitted with bilateral venous ulcers for over 13 years, because of difficulty of its diagnosis and treatment. At the time of admission, both lower limbs were extremely swollen with infected giant ulcers, surrounded by pigmentation and sclerotic skin. We performed careful therapy for ulcers with strong compression, simultaneously, ascending and descending phlebography and also echography were carried out. Deep vein reflux (Kistner classification, grade III) was confirmed. Ligation of saphenofemoral junctions of great saphenous veins, its branches and incompetent perforator interruption at the just below knee level, resection of varicous veins were performed as the first line of repair. Ligations of incompetent perforators at the site of ulcer formations after adequate evaluation of perforators were performed as the second operation. The good result could be evaluated from the standpoint of clinical and physiological improvement after these procedures. The simple surgical ligation of saphenous vein and incompetent perforator interruption under the accurate and careful evaluation is thought to be first preferable surgical procedures for venous ulcers of lower extremities, regardless of the degree of deep vein reflux.
