Sclerotherapy of saphenous vein combined with skin grafting for treatment of venous ulcers

Abstract

Background

Ulcers are the end result of varicose veins associated with reflux in saphenous veins.

Objective

To demonstrate the possibility of combining two procedures, foam sclerotherapy of saphenous veins and skin grafting, to treat patients with venous ulcers related to reflux in saphenous vein.

Methods

20 limbs were treated in 20 patients. All patients had ulcers related to saphenous vein reflux. We performed the grafting with expanded skin, followed by administration of ultrasound guided polidocanol foam sclerotherapy in veins associated with ulcers, accessed by puncture or dissection of the vein.

Results

In all cases there was improvement of ulcer-related symptoms and healing of the lesion. In 11 cases we achieved full skin grafting viability. In four cases there was healing of about 50% of the lesion and in the other five cases approximately 75% of the lesion healed. The first control ultrasonographic examination revealed complete sclerosis of the vessels treated in 19 of 20 cases, with partial sclerosis in one case, but no detectable reflux. The second ultrasonographic examination performed at 45 days showed complete sclerosis in 15 cases. In five cases there was partial sclerosis, without detectable reflux in three and with reflux in isolated segments associated with varicose veins in two. The most common complication was pigmentation along vein paths, observed in 13 patients. In one case there was asymptomatic thrombosis of muscle veins of the leg.

Conclusion

This combination of procedures is a valid option, with the potential to provide quicker and less expensive treatment.

Keywords:
leg ulcer; varicose ulcer; skin transplantation; sclerotherapy; varicose veins