There is a considerable difference between the results of SEPS on the medial side of the lower leg and the same procedure on the lateral side. SEPS on the lateral side of the lower leg, as performed in this small series, does not contribute to ulcer healing or recurrence. A considerable number of perforating veins are missed at surgery, resulting in persistent insufficient perforating veins postoperatively. The poor results of this study emphasize the need for adequate anatomic information to improve the surgical outcome.

Poor clinical results of lateral SEPS procedures might be improved after adjustment of the procedure for new anatomic information, which shows alignment of perforating veins along the intermuscular septa, obligating full septa dissection on the lateral side.