Feasibility of incompetent perforator vein excision using stab avulsion

Abstract

Objectives Whether incompetent perforator veins (IPVs) require treatment remains controversial. We retrospectively evaluated the feasibility of IPV excision performed using the stab avulsion technique without ligation and sutures in patients undergoing endovenous ablation (EA). Methods This was a single-center, retrospective, observational cohort study. EA was performed in 1503 consecutive patients, including 33 patients with ulcers, between December 2014 and May 2021. Varicectomy was performed using the stab avulsion technique; IPV cases were included. Results Stab avulsion was performed at a mean number of 11.4 ± 7.8 sites. No deep vein thromboses or pulmonary emboli were noted. The incidence of nerve injury was 0.3%. All 33 (100%) patients with ulcers achieved healing by 1 year (median: 55.5 days; range: 13–365 days). Conclusions IPV excision via stab avulsion may be a viable option for treating varicose veins and ulcers. This technique offers multiple advantages, including simplicity, safety, and reduced healthcare costs.

Evolution of moist wound healing: Methods of autologous tissue regeneration

“…A randomized clinical trial for early combination therapy with adjunctive endovenous ablation for saphenous vein re ux reported an ulcer healing rate of 93.8% and a recurrence rate of 11.4% after 1 year. 14 Endovenous ablation for venous re ux; varicose resection, including incompetent perforator veins using stab avulsion 15 ; and compression therapy are synergistic with moist wound healing and appropriate skin care for ulcers (see Online Methods). 3 The typical course of ulcer healing is shown in Fig.…”

“…Varicectomy, including the primarily affected veins and incompetent perforator veins, was performed using the stab avulsion method, without ligation and sutures. 15 Knee-length elastic stockings or elastic bandages were worn constantly for 1 week postoperatively. Thereafter, they were worn during daytime until wound healing.…”

Major impact of moist wound healing on autologous tissue regeneration: A review of ulcer treatment

“…Although clinical practice guidelines of the Society for Vascular Surgery recommend moist dressings for wound care, the rate of dressing usage, excluding gauze, in 2016 was <10% in Japan. Compared with conventional treatments such as disinfection and gauze, endovenous ablation of venous reflux; adequate varicose vein resection, including incompetent perforator veins 1 ; and compression therapy with moist wound healing 2 and appropriate skin care, yield more rapid epithelialization and prevent a recurrence. This study aimed to describe the widespread use of moist wound healing for venous ulcer treatment in Japan and its application to various wounds, particularly difficult‐to‐treat finger amputations and burns.…”