SURGERY OF THE PERFORATING VEINS OF THE L EG - OPEN AND ENDOSCOPIC TECHNIQUES

Surgical treatment of incompetent perforating veins of the leg is best carried out through a sub-aponeurotic approach after localisation by coloured Duplex-Scanning. Open techniques me long established, When th ere is only one perforator, a short 5 cm approach is centred over the previously localised perforator, In the presence of multiple perforato rs, un extensive approach is necessary. This usually means a single lo ng incision, situated para-tibially in the Linton approach, postero-me dially in the Dodd approach or posteriorly in the Felder approach. The advantage of the Inst two approaches is that they are situated at a d istance from any eventual cutaneous lesion. The approach can also be t hrough several separate oblique incisions (De Palma). More recently in troduced, endoscopic techniques have the advantage of reducing the inc idence of cutaneous complications such as necrosis or infections and o f shortening the duration of hospitalisation, Some authors work with r e-usable instruments. The perforators are divided after coagulation(Ha uer, Sattler). Others use disposable instruments. insufflate the sub-a poneurotic space and clip the perforators to prevent bleeding (Glovicz ki). These techniques are currently undergoing evaluation.