THE STUDY, CLINICAL IMPLICATIONS AND SOLUTIONS FOR FAILED VARICOSE VEIN SURGERY WITH RECURRENT VENOUS ULCERS: AN ANALYSIS OF 12 PATIENTS WITH DUPLEX SCAN CORRELATED WITH INTRA OPERATIVE FINDINGS AT SECOND SURGERY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2016, Vol 5, Issue 38
Abstract
BACKGROUND Venous ulcer is an under-recognized and under-treated disease and it affects quality of life. Chronicity and recurrence is disappointing finding, both for the patient and surgeon. AIM To study any surgically correctable factors in recurrent venous ulcers and clinical implications and to offer solutions that prevent or reduce failure rate of primary surgery in the management of venous ulcers. MATERIALS AND METHODS 12 patients with recurrent venous ulcers following previous procedures for varicose veins were enrolled in this study. Full detailed history, examination and investigations were done. RESULTS Out of 12 patients with recurrent venous ulcers, 10 (83%) had undergone saphenofemoral junction ligation and stripping, 2 (16%) had undergone laser ablation (Endovenous laser ablation), all had perforator ligation, 7 had undergone split skin grafting with ulcer recurrence, none had Saphenopopliteal junction ligation. When all patients were re-evaluated, we found that 5 patients had incompetent saphenofemoral junction, 2 of them in endovenous laser ablation group; 5 out of 12 had Saphenopopliteal junction incompetency. All 12 patients had incompetent perforators. All 12 of them underwent corrective surgery. All were followed up for 6 months to 36 months (Mean=25.5 months) with ulcers showing complete healing with no further evidence of breakdown during follow-up. CONCLUSION Surgery is recommended for venous ulcer patients in all stages. Preventable surgical errors are to be excluded for recurrent venous ulcers. Careful evaluation and accurate preoperative mapping of venous pathology with the help of sonologist experienced in vascular study. Role of surgeon experienced with vascular surgery will prevent failure rate
Authors and Affiliations
Gopinath Venkatarao, Nanda Lahoti
Keywords
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- EP ID EP118139
- DOI 10.14260/jemds/2016/535
- Views 70
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