A Case of Bilateral Chronic Venous Ulcers of Lower Limbs over 13 Years

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  • Murakami Atsubumi
    Division of Cardiovascular Surgery, International University of Health and Welfare Hospital
  • Kato Morito
    Division of Cardiovascular Surgery, International University of Health and Welfare Hospital

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  • 慢性静脈鬱滞症に起因する13年に及ぶ両側難治性下腿潰瘍の1例

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Abstract

<p>The accurate diagnosis and selection of surgical indication are very important for the treatment of venous ulcers. A 63-year-old woman was admitted with bilateral venous ulcers for over 13 years, because of difficulty of its diagnosis and treatment. At the time of admission, both lower limbs were extremely swollen with infected giant ulcers, surrounded by pigmentation and sclerotic skin. We performed careful therapy for ulcers with strong compression, simultaneously, ascending and descending phlebography and also echography were carried out. Deep vein reflux (Kistner classification, grade III) was confirmed. Ligation of saphenofemoral junctions of great saphenous veins, its branches and incompetent perforator interruption at the just below knee level, resection of varicous veins were performed as the first line of repair. Ligations of incompetent perforators at the site of ulcer formations after adequate evaluation of perforators were performed as the second operation. The good result could be evaluated from the standpoint of clinical and physiological improvement after these procedures. The simple surgical ligation of saphenous vein and incompetent perforator interruption under the accurate and careful evaluation is thought to be first preferable surgical procedures for venous ulcers of lower extremities, regardless of the degree of deep vein reflux.</p>

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