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Evaluates the anatomical and hemodynamic effects of superficial venous surgery and compression on legs with chronic venous ulceration. Treatment of legs with open or recently healed ulceration and saphenous reflex with multilayer compression bandaging or superficial venous surgery plus compression; Finding that superficial venous surgery resulted in a significant hemodynamic benefit for legs with venous ulceration despite co-existent deep reflux.

Presents an abstract of the article 'Risk Factors for Delayed Healing and Long-term Recurrence in Chronic Venous Leg Ulcers,' by J.R. Barwell, M. Taylor, A.S.K. Ghauri, C. Bronder, L. Phillips, K.R. Poskitt and M.R. Whyman.

Presents an abstract of the article 'Surgery Reduces Long-term Recurrence Rate in Chronic Venous Leg Ulcers,' by J.R. Barwell, M. Taylor, A.S.K. Ghauri, L.K. Phillips, M.R. Whyman and K.R. Poskitt.

Aims: A cost-effectiveness study was undertaken within the randomized trial comparing the cost and quality, of life (QoL) implications of four layer compression bandaging (4LCB) with, or without superficial venous surgery in patients with venous ulceration. Clinical results indicated that surgery did not influence healing but significantly reduced ulcer recurrence within one year from 24% to 12%. Methods: All NHS costs were recorded over one year. Leg ulcer clinic visits and 4LCB costs were included. In addition separate costs for visits to practice/district nurse were recorded. Surgery costs were calculated using the local data for Healthcare Related Groups (HRG) and compared with individually recorded costs per patient i.e. operative data, additional admissions. QoL tools (leg ulcer specific questionnaire, SF-36, EQ-5D) were sent out to a sample group at 1/12, 6/12 and 12/12. Results: Complete data were available on 330 patients (No surgery = 167, Surgery = 163). The mean cost per patient at one year follow-up for 4LCB and surgery was £1028 compared to 4LCB alone £781. The mean additional cost of surgery to heal one patient was £2245. SF36 and EQ-5D showed no significant changes in the quality of life from baseline to 6/12 or 12/12 in both groups. Conclusion: A strategy of early surgery for venous ulceration is more expensive over the first 12 months than 4LCB alone. Any cost advantage for early surgery will only be seen in the long term if ulcer recurrence is reduced. [ABSTRACT FROM AUTHOR]

Aims: To assess the effects of superficial venous surgery on anatomic and haemodynamic function in legs with chronic venous ulceration. Methods: Ulcerated legs with an ABPI > 0.85 undergoing surgical correction of superficial venous reflux were studied. Colour duplex imaging and digital photoplethysmography were performed before and 6 weeks following surgery. Legs were stratified into three groups: (A) isolated superficial reflux (n = 44), (B) superficial and segmental deep venous reflux (n = 23), and (C) superficial and total deep venous reflux (n = 12). Results: Seventy-nine limbs with chronic venous ulceration were studied. Superficial venous surgery abolished segmental deep reflux in 9 of the 23 legs (group B) but only abolished total deep reflux in 1 of the 12 legs (group C) (P = 0.03, Chi-square test). Surgery improved median (range) venous refill time from 10 (4–48) to 21 (9–48) s in group A, 11 (4–38) to 16 (6–36) s in group B, and 9 (3–24) to 11 (6–32) s in group C (P < 0.001, P = 0.06 and P = 0.08, respectively). Conclusions: Superficial venous surgery may correct segmental deep venous reflux, but has little effect on total deep reflux. Superficial venous surgery improves venous haemodynamic function in ulcerated limbs with isolated superficial reflux, and may improve haemodynamic function in legs with mixed superficial and segmental deep reflux. [ABSTRACT FROM AUTHOR]

Aims: Elderly patients with chronic venous ulceration may benefit from venous surgery, but often wish to avoid general anaesthesia. The aim of this study was to compare the effectiveness of sapheno-femoral disconnection (SFJD) under local anaesthesia and SFJD plus stripping of the long saphenous vein under general anaesthesia in legs with chronic venous ulceration. Methods: Patients with chronic venous ulceration were assessed with colour duplex imaging to identify those with sapheno-femoral junction reflux. Patients underwent either SFJD alone under local anaesthetic or SFJD with stripping under general anaesthetic. Twenty-four-week ulcer healing rates and 12-month ulcer recurrence rates were compared. Results: The median (range) age of patients undergoing SFJD alone was 81 (46–90) years (n = 30) and of patients undergoing SFJD plus stripping was 68 (31–86) years (n = 83). Age-adjusted 24-week ulcer healing rate was 62 per cent for both groups. Twelve-month ulcer recurrence rates were 14 and 12 per cent, respectively (P = 0.39, Kaplan–Meier survival analysis). Conclusions: SFJD plus stripping has no additional short-term benefit over SFJD alone in legs with chronic venous ulceration. [ABSTRACT FROM AUTHOR]

Assesses the effects of superficial venous surgery on ulcerated legs with deep venous reflux. Performance of surgical correction of superficial reflux; Calculation of venous refill times before surgery; Changes in the plethysmography-derived hemodynamic.

Presents various correspondence related to surgery. Advantage of pinch skin grafting of venous ulcers than larger ulcers; Importance of precision in varicose vein surgery; Risks of cancer associated with common bile duct excision.