Comparison of shave therapy and crural fasciectomy in the treatment of so-called therapy resistant venous leg ulcers

Aim and Methods: From January to December 1997 13 patients with 18 non-heal ing venous ulcers were treated by shave therapy in the Department of Dermat ology and Venereology of the Medical University of Lubeck; in the same peri od 10 patients of the same age group with 14 recalcitrant ulcers were treat ed by crural fasciectomy in the William-Harvey-Klinik in Bad Nauheim. All u lcers were a result of deep venous insufficiency; they were caused either b y primary or secondary deep varicosis or by postthrombosis. An arthrogenic congestive syndrome was found in all patients. Results: 3 months and 1 year after surgery no significant differences between the groups according to n umber of ulcer persistence or ulcer recurrence could be found. After one ye ar complete healing was found in 11 from 18 ulcers (61,1%) of the patients with shave therapy and in 9 from 14 ulcers (64,3%) of the patients with fas ciectomy. The average reduction of ulcers was more pronounced following fas ciectomy; but in these patients the hospitalisation (49,8 days) was double as long compared to those with shave therapy (24,1 days). Conclusion: The s tudy shows, that in recalcitrant venous leg ulcers both treatment modalitie s show similar clinical results one year after surgery. Within this period the removal of the fascia with opening of the dorsal compartments did not p rove to be of obvious advantage.