After the long standing application of the tumescent solution with percutaneous sticks the tumescent technique in combination with the Rofil Medro-pump represents at the moment a very elegant and innovative method of local anesthesia in the field of phlebosurgery. Since 1997 the tumescent technique has been used in our hospital for all major surgeries in the field of phlebosurgery. Even more difficult operations like inguinal relapse-varicosis or acute thrombophlebitis are successfully performed with this method. From our experience the advantages of this method are a reduced bleeding, less hematomas, an insignificant risk of thrombosis and embolism, an antibacterial effect, the hydrodissection and anodynia. Using very large volumes painless surgical treatment of complicated and extended findings is possible. Essential disadvantages (like a wet surgical field, which needs to get used to) hardly exist neither for the patient nor for the surgeon. Therefore, the tumescent technique represents a safe, comfortable and almost painless kind of local anesthesia of the skin and the subcutaneous fatty tissue.

Confusion exists regarding the right surgical strategy for therapy of isolated varicosis of the lateral accessorian saphenous vein (LASV) resulting from an incompetent valve at the crosse without concomitant reflux into the long saphenous vein (LSV). In a retrospective study 30 patients with isolated varicosis of the LASV were examined 3 years after surgical treatment. In this study the first segment of the LSV was removed after resection of the LASV. 64% of our patients were free of recurrence after 3 years. 25% had partial reflux from the Boyd perforans vein and only 9% of the patients had a complete reflux in the LSV. Based on our results it is justified not to remove the LSV in cases of isolated varicosis of the LASV.

ZusammenfassungWährend Anfang des 20. Jahrhunderts phlebochirurgische Eingriffe in Äther- oder Chloroformnarkose durchgeführt wurden, etablierte sich gegen Ende des 20. Jahrhunderts die Lokalanästhesie in der Phlebochirurgie. Bis zur Erstbeschreibung der Tumeszenzlokalanästhesie durch Klein im Jahre 1987 wurde die Lokalanästhesie konventionell (Lokalanästhetikum mit NaCl verdünnt) eingesetzt. Anfang der 90er Jahre fand die Tumeszenzlokalanästhesie in Deutschland ihren Einzug in die Phlebochirurgie und hat seither phlebochirurgische Eingriffe in Intubationsnarkose in den Hintergrund gedrängt. Aufgrund zahlreicher Vorteile und geringer Nachteile stellt die Tumeszenzlokalanästhesie am Anfang des 21. Jahrhunderts eine sehr sichere und komfortable Methode unter den lokoregionalen Betäubungsverfahren dar.