Abstract
Purpose: We have already reported that subfascial endoscopic perforator vein surgery (SEPS) promotes the healing of venous ulcers in patients with chronic venous insufficiency. However six of 53 limbs still had active ulcers after SEPS. The duration of ulceration had a significant influence on healing after SEPS, and unhealed ulcers were likely to be multiple and larger than 2 cm in diameter. However it was difficult to predict which ulcers could be cured by SEPS with or without superficial venous ablation (SVA). This study was designed to investigate whether the transcutaneous oxygen tension (tcPO2) could be a predictor of venous ulcer healing in chronic venous insufficiency patients treated by SEPS. Materials and Methods: The tcPO2 was examined in patients with active or inactive venous ulcers (C5, C6). Measurement was done with a 6-channel TCM400 (Radiometer Copenhagen) simultaneously on both thighs, both calfs, and above the medial malleoli in the supine and upright positions. The same measurements were also done in healthy adults and in varicose vein patients without stasis dermatitis (C2) as a control group. Results: In the control group, tcPO2 increased in the upright position at the three sites of measurement. On the other hand, tcPO2 above medial malleoli, (where venous ulcers are common) was lower in the patients with chronic venous insufficiency than in the control group, and did not change or decreased in the upright position (dip/flat pattern), unlike the results in the control group (bulge pattern). Discussion and Conclusion: Intractable ulcers are likely to be associated with more extensive fibrin deposition around capillary vessels, leading to impaired diffusion of oxygen. The decrease of tcPO2 in the upright position (dip/flat pattern) may have resulted from peri-capillary fibrin deposition, and thus may be a sign of intractability. Therefore, we conclude that measurement of tcPO2 with positional changes can be a predictor of venous ulcer healing in chronic venous insufficiency patients. In dip/flat pattern, there will be a possibility of recurrence and strict leg care will be needed ulcers heals.
