Surgical Treatment of Incompetent Perforator Veins by Subfascial Ligation

Background: Chronic venous ulceration of the leg is a commonpresentation in surgical clinics. Although, the majority of ulcerscan be healed by simple compression. Some chronic ulcers withvenous competencies require correction surgeries. We in thecurrent study tried to study the role of Cockett and Dodd'soperation of subfascial ligation of below-knee perforator veinsin the treatment of varicose veins of the lower limbs.Methods: This cross-sectional study was done in theDepartment of General Surgery, Prathima Institute of MedicalSciences, Naganoor, Karimnagar. N=40cases of varicosities ofthe lower limbs with perforatorincompetence with or withoutsaphenofemoral incompetence. The patients were treated withperforator ligationalone with the Cockett and Dodd methodor in combination with the stripping procedure.Results: The clinical classification shows C5 healed venousulcers and C6 active venous ulcers. 64% of cases belonged tothese two categories and no case of C1 was found in our study.Perforator incompetence only was found in n=25 cases whereperforator ligation alone was done given in table 4. In n=15cases, perforator ligation and stripping with or without ligationof sphenopopliteal junction was done. The minimal meanduration of stay was 5.5 days the maximal mean duration ofstay was 8.0 days.Conclusion: Open subfascial perforator ligation by Cockett andDodd's procedure is a good procedure in the treatment ofprimary varicose veins with perforator incompetence. The ratesof complications can be largely reduced by careful patientselection and skill full operative techniques. Follow-up ofpatients must be done at intervals for the development of newincompetent perforating veins and varicosities which may leadto the recurrence of ulcer formation.