Volume: 9 Issue: 2
Year: 2021, Page: 53-57, Doi: https://doi.org/10.47799/pimr.0902.12
Received: Jan. 15, 2021 Accepted: Feb. 3, 2021 Published: Feb. 3, 2021
Background: Chronic venous ulceration of the leg is a common presentation in surgical clinics. Although, the majority of ulcers can be healed by simple compression. Some chronic ulcers with venous competencies require correction surgeries. We in the current study tried to study the role of Cockett and Dodd's operation of subfascial ligation of below-knee perforator veins in the treatment of varicose veins of the lower limbs.
Methods: This cross-sectional study was done in the Department of General Surgery, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. N=40cases of varicosities of the lower limbs with perforatorincompetence with or without saphenofemoral incompetence. The patients were treated with perforator ligationalone with the Cockett and Dodd method or in combination with the stripping procedure.
Results: The clinical classification shows C5 healed venous ulcers and C6 active venous ulcers. 64% of cases belonged to these two categories and no case of C1 was found in our study. Perforator incompetence only was found in n=25 cases where perforator ligation alone was done given in table 4. In n=15 cases, perforator ligation and stripping with or without ligation of sphenopopliteal junction was done. The minimal mean duration of stay was 5.5 days the maximal mean duration of stay was 8.0 days.
Conclusion: Open subfascial perforator ligation by Cockett and Dodd's procedure is a good procedure in the treatment of primary varicose veins with perforator incompetence. The rates of complications can be largely reduced by careful patient selection and skill full operative techniques. Follow-up of patients must be done at intervals for the development of new incompetent perforating veins and varicosities which may lead to the recurrence of ulcer formation.
Keywords: Subfascial ligation, varicose veins, Cockett and Dodd’s method
1. In: Adams EF, ed. Hippocrates: The Genuine Works of Hippocrates, vol 2. New York: Wm Wood & Co; 1886:305.
2. Ruehm SG, Zimny K, Debatin JF. Direct contrast-enhanced 3D MR venography, Eur Radiol. 2001. 11: 102–112.
3. Porter JM and Moneta GL. Reporting standards in venous disease: An update international consensus committee on chronic venous disease. J. Vasc Surg. 1995; 21(4): 635- 645.
4. Babcock WW: A new operation for extirpation of varicose veins of the leg. N Y Med J 1907; 86:153.
5. Linton RR: The post-thrombotic ulceration of the lower extremity: Its etiology and surgical treatment. Am J Surg 1953; 107: 415.
6. Caggiati A. Fascial relationships of the short saphenous vein. Journal of Vascular Surgery. 2001. 34(2): 241–246.
7. Caggiati A, Bergan JJ, Gloviczki P, et al: Nomenclature of the veins of the lower limbs: An international interdisciplinary consensus statement. J VascSurg 2002; 36:416.
8. Cockett Fb. The pathology and treatment of venous ulcers ofthe leg. Br J Surg 1956; 44: 260-278.
9. Dodd H. The diagnosis and ligation of incompetent perforating veins. Ann R Coll Surg Engl 1964; 34: 186-196.
10. Kumar SN, Shirisha M. The Role of Subfascial Ligation of Perforator Veins by Cockett and Dodd Method in the Treatment of Varicose Veins. IOSR Journal of Dental and Medical Sciences 2017 May;16(5):9-18.
11. O'Donnell TF, Burnand KG, Clemensong, Thomas Ml,Browsenl. Doppler examination vs clinical and phlebographicdetection of the location of incompetent perforating veins. ArchSurg 1977; 112: 31-35.
12. Field P, Van Boxel P. The role of the Linton flap procedure in the management of stasis, dermatitis, and ulceration in the lower limb. Surgery 1971; 70: 920-926.
13. Wilkinson GE, Maclaren LF. Long term review of procedures for venous perforator insufficiency. Surg Gyn Obstet 1986; 163: 117-120.
14. Negus D. Prevention and treatment of venous ulceration. Ann R Coll Surg Engl 1985; 67: 144-148.
15. Cikrit DF, Nichols WK, Silver D: Surgical management of refractory venous stasis ulceration. J VascSurg 1988; 7:473- 478.
16. Stuart WP, Asam DJ, Bradbury AW, Ruckley CV. Subfascial endoscopic perforator surgery is associated with significantly lessmorbidity and shorter hospital stay than open operation, Br J Surg. 1997. 84: 1364–65.
17. Sybrandy JE, van Gent WB, Pierik EG, Wittens CH. Endoscopic versus open subfascial division of incompetent perforating veinsin the treatment of venous leg ulceration. J Vasc Surg 2001; 33:1028-32.
G Chandra Shekar Goud. Surgical Treatment of Incompetent Perforator Veins by Subfascial Ligation.Perspectives in Medical Research 2021; 9 (2):53-57 DOI:10.47799/pimr.0902.12