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The deep fascia under laparoscopic ligation veins treatment of chronic venous ulcer


Abstract purpose of the deep fascia of laparoscopic ligation of veins under the treatment of chronic venous ulcers. Methods 24 patients with varicose vein surgery patients, and 24 cases of superficial venous reflux were also there, the traffic branch venous insufficiency, deep venous insufficiency and venous ulcer. Endoscopic surgical procedure for the deep fascia ligated veins, great saphenous vein high ligation and stripping of varicose veins and leg Percutaneous Suture consecutive ring, of which 12 patients were performed outside the repair of superficial femoral vein valve plasty. Results limb symptoms and varicose veins disappeared in 19 patients with venous ulcer healing in the short term,[link widoczny dla zalogowanych], significantly reduced in 5 cases. Conclusion Endoscopic deep fascia, ligation of veins under the safe and effective, damage, fewer complications, the treatment of venous insufficiency ulcers and important part of effective methods.
Key words mirrors; varices; lower extremity; ulcer
Chronic venous insufficiency and venous leg ulcers are not rare, venous hypertension is the main reason [1]. Despite bed rest, elevation and other non-surgical treatment of lower limb, part of the ulcer may heal, but most easy to relapse, and thus must stand up and timely treatment of portal hypertension [2]. We have recently applied line by endoscopic ligation of deep fascia, veins under the treatment of 24 cases of chronic venous ulcers, curative effect satisfaction, are reported as follows.
1 Materials and Methods
1.1 General Information in November 2002 ~ January 2007 24 patients were admitted to exist superficial venous reflux, veins insufficiency, deep venous insufficiency with chronic venous ulcer of the patients, 18 males and 6 females, aged from 42 to 67 years old, varicose veins course of 10 to 45 years, ulcer duration 1 to 5 years, 14 patients had lower limb soreness sense into leg marked tortuosity of the superficial group varicose veins, pigmentation, foot ulcers are active boot area, a diameter of about 3 ~ 9cm size, 24 patients were done antegrade venography and color Doppler (Acuson-128X type, 7MHz), as it may see the light varicose vein reflux and deep venous reflux in the number of levels [3]; with cuff pressure release test checks veins, insufficiency can see the direct connection of deep vein and superficial vein of the traffic vein, the chamber has a two-way flow [ 4,], all patients ankle / brachial index greater than 0.18, except for arterial ischemic ulcers can be.
1.2 surgical procedure used epidural anesthesia, deep fascia Ligation of the mirrors under, home air-limb thigh tourniquet, pressure 7312 ~ 7918kPa (550 ~ 600mmHg), so that endoscopic surgical field was no blood state,[link widoczny dla zalogowanych], in the middle of the medial tibia 3 ~ 4cm Department for over 1 ~ 2cm longitudinal incision fascia,[link widoczny dla zalogowanych], blunt fingers and gently separate fascia space, as close to the medial malleolus, hit the cable when not blindly peel like tissue, probably because of their veins, in order to avoid damage to the fracture, from the incision into diameter 16mm or 20mm SEPS Endoscope in the space under the fascia to insert foot up malleolus, fascia CO2 gas perfusion to maintain the pressure of 313 ~ 410kPa (25 ~ 30mmHg), on the TV screen can clearly see the thick vein of traffic, the operation 5mm diameter hole cut into an ultrasonic knife to cut off traffic ultrasound vein, the large veins with a titanium clip clamp off, until the leg fascia can see veins under the cut all the ligation, this group of patients in each case can be seen that traffic vein 2 ~ 5, while lower limb veins varicose great saphenous vein high ligation line, and the great saphenous vein stripping to the knee, percutaneous continuous circular suture superficial venous leg varicose vein [1], there are 12 cases of superficial femoral vein external valvuloplasty procedure [3] and after 2 days, and activities to encourage patients to leave bed.
1.3 Results limb symptoms and varicose veins disappeared in 19 patients with venous ulcer healing after 24 to 35 days, five cases of significantly reduced after operation in non-venous Regional occurrence of ulcers by ultrasound ablation of the skin necrosis in 1 case, 4 weeks after healing.
2 discussions
2.1 veins insufficiency in lower extremity venous ulcers in the significance of the traffic branch venous insufficiency in lower extremity varicose veins play an important role, but in the treatment of venous ulcer is to deal with dysfunction in veins are still controversial [5]. The normal function of veins is the blood of superficial venous drainage system to the deep venous system, and then return to the heart, veins in the formation of venous leg ulcers is important. On the one hand, in the event of superficial venous reflux, if veins function normally, to the deep venous system, increasing blood flow, resulting in hypertension, deep vein dilation, and subsequent deep venous insufficiency; the other hand, such as traffic Support venous insufficiency, the lower extremity superficial venous blood to the legs caused by the abnormal reflux venous stasis, local micro-circulation changes, polymorphonuclear leucocytes and exudate,[link widoczny dla zalogowanych], skin nutrition disorders, there Persistent ulcers, venous insufficiency at this time traffic support on the foot boot area of the skin especially harmful [2 5].
2.2 deep fascia Ligation of treatment of venous ulcers over a hundred years ago, the traffic branch venous insufficiency in lower extremity venous ulcers of the role has been neglected [4], on veins of the deep fascia under veins ligation, which Linton surgery and improved surgical, trauma due to large and there is delayed wound healing, wound infection, necrosis of skin, its application is limited, minimally invasive surgery the concept of creation and the development of endoscopic surgery, with endoscopic ligation in the deep veins under the fascia (subfascial endoscopic perforator surgery, SEPS) has been widely used step by step. [4] PS is safe and effective, and the operation is not complicated, a small incision through the calf can be exploration and ligation of the leg veins, reducing surgical trauma and postoperative complications.
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