CHRONIC VENOUS INCOMPETENCE

In severe chronic venous insufficiency (CVI) the fascia cruris is incr easingly involved in the pathological process. The resulting loss of c ompliance as a consequence of altered fascia texture leads to increase d pressure in the compartments of the lower extremity, followed by red uced circulation. Arteries and nerves, which penetrate the fascia alon g with insufficient perforating veins, are damaged through the increas ed pressure and are therefore functionally impaired. Accordingly many pathological changes in the crural ulcer have their anatomical substra te here. The micorcirculation is disturbed by either primary varicosis with secondary insufficiency of the deep veins or by primary insuffic iency of the deep venous system as seen in a postthrombotic syndrome. Subsequent therapy should be based on this knowledge and therefore con sists of medication and basic physical therapy along with dissection o f the perforating veins - fasciotomy and fasciectomy combined with pla stic surgery. All of the therapeutic measures have to take the stage o f the CVI into consideration. In order to eliminate the insufficient p erforating veins and to perform fasciotomy the endoscopic approach is considered the state of the art. In extreme cases, only fasciectomy co mbined with plastic surgery can lead to durable healing.