The importance of the direct perforating veins of the lower leg in the aetiology of venous ulceration is supported by the results of a 6-year study of 77 patients with 109 ulcerated legs. Incompetent perforating veins were demonstrated by examination and Doppler ultrasound, and confirmed at operation, in 108 legs. Subfascial ligation of these veins, with stripping of incompetent saphenous veins when necessary, was followed by elastic compression stockings in 44 legs (40 per cent) in which deep vein incompetence was demonstrated by non-invasive methods and phlebography. Some 91 ulcers (84.3 per cent) remain healed (76 per cent greater than 3-year follow up). Eight patients with rheumatoid arthritis in addition to venous incompetence had a 75 per cent failure rate. If these patients are excluded, 88 (92 per cent) of 96 ulcerated legs remain healed. It is submitted that these results support the argument for the importance of perforating vein incompetence in the aetiology of venous ulceration. They also suggest that a more optimistic attitude towards treatment is justified.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.