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Leg ulcers caused by chronic venous insufficiency remain a therapeutic dilemma. Their optimal clinical (conservative or surgical) management is still controversial if not problematic. We present our experience with a therapeutic modality including a paratibial fasciotomy and dissection of the posterior perforator veins (Hach procedure) for the treatment of patients with chronic venous ulcers. Patients, methods: Between January 2001 and May 2005 62 patients, (40 women and 22 men) with active venous ulcers in the legs (CEAP 6) were included in the study. Patients were submitted to a paratibial fasciotomy with subfascial dissection of the posterior perforator veins. Results: During a four years study period, we performed 67 fasciotomies in 62 patients with chronic venous ulcers. In 43 limbs besides a fasciotomy we performed a saphenofemoral junction ligation and stripping. In 28 ulcers we used a vacuum-assisted therapy (V.A.C) for median time eight days. Furthermore, 22 patients with ulcers larger than 3 x 3 cm received an autologous skin graft. The cumulative ulcer healing rate after fasciotomy was 29% in three months, 52% at six months and 97% in one year. Ulcers size was found to be significantly related to healing time (p < 0.001). Conclusion: Paratibial fasciotomy is an effective method for the treatment of patients with chronic venous ulcers. This therapeutic modality could be safely applied in cases when other more conservative therapeutical measures fail. © 2007 Schattauer GmbH.

Allyl-alcohol (AA) and carbon tetrachloride (CC14) are known to cause peritoneal and pericentral liver necrosis, respectively. This study investigates pathological changes of hepatic artery and portal vein after simultaneous administration of AA and CC14 in rats.The study comprised 130 male Wistar rats divided randomly into 2 groups: I (n=10) sham and II (n=120) AA injection (intraperitoneally: 0.62 mmol/kg) and rhinogastric administration of CC14 (0.66 ml/kg, 1:1 volume dilution in corn oil). After injection was completed, animals of group II were assigned in 12 categories and sacrificed 2, 4, 6, 12, 18, 24, 33, 48, 57, 81, and 153 hrs after. Tissue was obtained from the left anterior lobe and the hilum of the liver, and histological examination included HE, silver methenamine and van Giesson stains.Liver sections from group II (AA+CC14) demonstrated periportal together with pericentral necrosis; the peak was 57 hrs after injection. In all 120 cases, HE stain showed evidence of regeneration originated from zone 2, extending to zone 1 and occasionally to zone 3, and accomplished mainly by non-necrotic cell proliferation. Sections from the liver hilum showed thrombosis of the portal vein, whereas the hepatic artery and its branches developed a variety of changes. Initially (2, 4 hrs), endothelial hypertrophy was observed which was followed by focal fibrinoid necrosis of the arterial wall (6 hrs). Later on (9-153 hrs) the following findings were present: hyperplasia and non-isometric cytoplasmic vacuolisation of media, disruption of the elastic lamina, aggregation of foam cells and macrophages in intima, media, and focally in adventitia of hepatic artery; and lymphocytic inflammation of intimal and periadventitial area. In 2 cases (153 hrs) hepatic artery thrombosis was present.Additionally to liver parenchymal changes, simultaneous administration of allyl-alcohol and carbon tetrachloride in rats results to vascular changes mainly in the hepatic artery and its branches. During liver parenchymal regeneration, the hepatic artery and its branches develop microscopic features that morphologically resemble those of atherosclerosis. These changes may result in hepatic artery thrombosis and or obstruction.

Venous thromboembolism (VTE) is a common complication in patients undergoing surgery. The risk for VTE is determined by the combination of individual predisposing factors and features of the specific type of surgery. Although the knowledge about VTE has increased enormously during the last years VTE-prophylaxis is still inadequate. The goals of our study were to assess the correctness of the adjusted pharmacological prophylaxis, and the difference of the VTE-risks in the different surgical departments.During a three months period, 451 patients were prospective included. These patients were admitted to the Departments of Vascular and General Surgery and of Traumatology of our hospital. Based on the modified Hertfelder's VTE-risk-assessment model, we scored the patients and categorized them into 4 groups: low, moderate, high and very high risk for VTE. We enrolled every admitted patient taking their medical history and reviewing medical documents.The mean cumulative risk value for VTE-risk was 3.68 (median 3.5, minimum: 0, maximum: 13 and standard deviation: 2.206), whereas 20.2% of our patients had a low, 27.2% middle, 21.7% high and 30.9% very high risk. The patients with vascular procedures had significantly higher mean value (5.03, SD 2.2) than the patients with general operations (3.6, SD 2.2) and those who underwent traumatology (3.06, SD 1,8) (P value0.001). The majority of patients (n=356), (78.9%) received VTE-prophylaxis with low dose of low molecular weight heparin (LMWH). Of the remaining patients, 40 (8.9%) received therapeutic dose and 55 (12.2%) received none VTE-prophylaxis.The VTE-risk for surgical patients remains high, despite all efforts for prophylaxis. The main reason may be that risk-assessment is time consuming and not standardized. We demonstrated that VTE-risk for patients in vascular surgery is significantly higher than the VTE-risk for patients in general and trauma surgery. We also showed that the VTE-risk in some patients was underestimated and prophylaxis was inadequate. Therefore, it is recommended to emphasize more on short risk-assessment, adequate prophylaxis and optimal dosage in order to prevent deep venous thrombosis and embolism disease.