EARLY BENEFITS OF SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY (SEPS) IN HEALING VENOUS ULCERS

Efficacy of subfascial endoscopic perforator vein surgery (SEPS) in as sisting the healing of venous ulcers was determined. During the period June 1995 to May 1996, 19 limbs in 17 patients were treated by SEPS. Thirteen limbs had open ulcers (class 6), five limbs had healed ulcers (class 5), and one limb had severe lipodermatosclerosis (class 4). Th ere were nine male and eight female patients (average age 58, range 33 -86). One male had bilateral open ulcers and one female had one open a nd one healed ulcer. Open ulcers had been present for an average durat ion of 4.4 years (range 1-14 years). The average ulcer size was 2.8 x 2.2 cm (range 1 x 1 cm to 12 x 6 cm). All operations were conducted on an outpatient basis. At surgery an attempt was made to correct all su perficial venous pathophysiology. In addition to SEPS, 12 limbs (63%) had greater saphenous vein (GSV) stripping and 15 patients (79%) had s tab avulsion of painful varicose veins. The average number of perforat ors ligated during SEPS was 3.68 (range 2-8). All active ulcers healed within 90 days. The mean time to healing was 30.5 days (range 6-90 da ys). Minor postoperative complications (one groin hematoma, three woun d infections) occurred in four limbs (21%). There have been no ulcer r ecurrences during follow-up (mean 8.6 months, range 3-16 months). Outp atient SEPS is an important adjunct in the treatment of chronic venous insufficiency. Experience in this group of 19 limbs strongly suggests that SEPS appears to accelerate the healing of venous ulcers compared to historical controls.