Valve Repair and Wrap Round: Role of Femoral Vein Valve Repair in Recurrent Chronic Venous Stasis Ulcers

Role of Femoral vein valve repair in recurrent chronic venous stasis ulcers. Dinakaran Karthikezhiyam Gopinathan MS, MCh, Geetha Vasu MD, Aparna Suresh MBBS, Anagha Sathyan MBBS Rtd professor Calicut medical college, Consultant cardio-vascular and thoracic surgeon, SIMS (Sankers hospital) KOLLAM and Associate in general surgery DM WIMS, Medical college, Meppadi, Wayanad. Objective This study is mainly intended to high light the results of venous valve repair (VVR) when all other modalities of treatment has failed to get the desired results (ulcer healing). Method We have selected 28 patients who had non healing ulcers after the classical treatment, like compression therapy, Trendelenburg surgery, saphenous vein stripping and perforator ligations. The study extended for a period of 9 years from 2009 to 2018 and these patients were having painful non healing ulcer for more than 1 to 2 12 years. Patients with recurrence of symptoms were grouped under CEAP grade as 3& 4 according to US doppler evaluation, and then taken for definite treatment. ( primary deep vein valve repair and wrap round with fascia lata). Post operative evaluation was done with US Doppler study and the healing of wound assessed by sterile blotting paper assessment, and any reduction in size of the ulcer from the pre- operative assessment, was taken as improvement. This is mainly a retrospective analysis and no personal details of the patient were given in this study and hence ethical evaluation not needed. All patients were treated by the first author himself. Results This study showed a reversion of the reflux from Grade 3& 4 for a total of 25 out of 28 cases which is considered as good result and 3 patients in the main group out of 28 continued to be in the severely diseased group 3 and had no complete healing of the wound was seen even after 1 year. In other words 89.2 % of the cases had good recovery and 10.8 % of the cases had no complete remission even after 1 year even though they are symptomatically better. . All the cases were followed for a further period of 3 to 5 years with no further deterioration of the Doppler findings.