The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis

Abstract

Aim Analysis of the radical removing of the dermatosclerotic tissues and ulcer(s) with perforator veins dissection as well as local wound and standard compression treatment of CEAP C5/6 stage in a prospective comparative cohort study. Primary endpoint is to compare the results of the one-year follow-up regarding quality of life, vein clinical severity score, and ulcer healing process. Secondary endpoint is the precise presentation of the surgical technique. Tertiary endpoint is to demonstrate the photo-documented results of the postoperative wound treatment protocol. Method Clinical and statistical comparison of radical surgery versus solely wound care and compression in a cohort of 15 patients in each group (Groups 1, 2). In Group 1, radical removing of the dermatosclerotic pannicule and leg ulcer, perforator vein dissection, great saphenous vein, or small saphenous vein was performed. Quality of life , pain intensity, vein clinical severity score and patients' load capacity were compared. The tissue oxygen saturation changes were monitored via near infra-red spectroscopy. Results Both groups were statistically comparable. Wound healing in the operated group was 100% versus 60% in the second one, the difference was significant, p = 0.006. The quality of life: 45.33 versus 36.8, p < 0.001, intensity of leg restless and pain: 2.28 versus 5.3, p < 0.001, changes of vein clinical severity score: 5.27 versus 20.93, p < 0.001, changes of tO: 19.00 versus 6.07 in the upper third of the leg p < 0.001, proved significantly better in group 1 compared to 2. Load capacity was significantly better in group 1 than 2 at the end of the study. The average wound healing time was 113 days in group 1. Conclusion The radical surgery provides significantly better results, considering quality of life, vein clinical severity score, load capacity than the conservative treatment in this study.

Reply letter to the editor, regarding the role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis

“…Dear Sir, Thank you very much for your comments 1 on our article published in Phlebology, titled ''The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis.'' 2 Treating patients with CEAP C5/6, recurrent ulcers, dermato-liposclerosis, concurrent perforator vein insufficiency, GSV/SSV insufficiency is a considerable challenge and one of the hardest tasks in phlebology. The mutual endeavour of the treating staffs is to offer the most appropriate solution to patients in their current CEAP stage.…”

Letter regarding the role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis

“…Dear Editor, I read with interest the paper, ''The role of radical surgery in the management of CEAP C5/6 and lipodermatosclerosis'' by Ga´bor Martis and Rena´ta Laczik. 1 I would like to congratulate the authors on bringing a very useful technique to the literature which mirrors, and greatly adds to, a presentation of our early results of a similar approach that we used to follow and that we presented at the UK Venous Forum in 2000. 2 However, we subsequently moved to a more conservative interventional approach by correcting underlying venous reflux in truncal veins using endovenous thermoablation and in perforating veins using the TRLOP technique.…”