A CLINICAL AND HEMODYNAMIC INVESTIGATION INTO THE ROLE OF CALF PERFORATING VEIN SURGERY IN PATIENTS WITH VENOUS ULCERATION AND DEEP VENOUS INCOMPETENCE

Objective: To determine the clinical efficacy and local haemodynamic e ffects of perforating vein surgery in ulcerated limbs with combined de ep and perforating vein incompetence. Design: Prospective, interventio nal study. Materials and methods: Seven ulcerated limbs with combined primary deep and perforating vein incompetence were studied. Clinical efficacy was determined by ultimate ulcer healing and reduction in ulc er area, local haemodynamics were assessed at three sites with photopl ethysmographic 90% venous refilling times (PPG RT90); both assessments were performed pre- and 1-month postoperatively. Results: None of the ulcers healed following perforating vein surgery, the median (range) ulcer areas pre- and postoperatively were 31 (7-685) cm(2) and 35.5 (7 -796) cm(2) (Wilcoxon p=0.07). Preoperative PPG RT90 demonstrated a gl obal abnormality of venous function at all sites examined that persist ed after perforating vein surgery. Conclusion: In the presence of deep venous incompetence perforating vein surgery had no influence on veno us function or ulcer healing. We conclude that perforating vein surger y is not indicated for the treatment of venous ulceration in limbs wit h primary deep venous incompetence.