Combined compressive-surgical treatment of chronic venous ulcer of the leg

More than 40 years is well known that venous ulcers are closely associated with the presence of subcutaneous venous hypertension and are a major problem for treatment. Chronic illness, prolonged conservative treatment often without results, frequent recurrences, surgery, back again to the forefront of treatment of deep venous leg ulcers. Objective: The aim of this study was to show whether the ligation insufficient perforating veins in the lower leg with the use of postoperative compression therapy can significantly improve wound healing and preventing the emergence of new ulcers compared only to compression therapy. Materials and methods: This prospective study covers the period from 2007-2010 year. There were 52 patients divided into two groups of 26 patients who were treated at the Clinic of Orthopedics and Traumatology, Clinical Centre of Sarajevo University. In this study was represented both sexes, the average age was 52.6 years. All patients had ulcus cruris in the third stage, the first group underwent ligation of Cocketts perforating veins, debridement, daily dressing and application of compression therapy with a pressure of 20 mmHg and for the control group is applied graduated compression therapy, which involves about 40 mmHg to toe 20 mmHg below the knee, with local wound therapy. Postoperative flow-up was a year ago. Results: In group A patients post-operatively there was a tendency of healing. In 19 patients (70%) there was complete healing of wounds and the loss of subjective symptoms, 4 patients (20%) had poor healing of wounds and 3 patients (10%) there was no healing of wounds. In group B in 9 patients (30%) had complete healing of wounds, part 2 patients (10%) and nonunion was found in 15 patients (60%). All wounds were colonized Staphylococcus aureus (70%), Escherihia coli (44%), Proteus (21%), Pseudomonas auruginosa (62%), Acinetobacter calcoacceticus (6%), which in all patients a mixing type of infection. Antibiotics are used to antibiogramu. Conclusion: Surgical treatment of compression- healing chronic venous leg ulcers is a safe, efficient and faster way for ulcers, but surely only conservative therapy. Complications are minimal, the rate of healing is relatively high (70%).