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The Journal of Cardiovascular Surgery 2003 April;44(2):249-53

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Chronic venous ulcer treatment with fascial pedunculated graft

Montisci R., Ruju C., Massoni G., Sanfilippo R., Brotzu G.

Department of Vascular and Thoracic Surgery, University Polyclinic Hospital, University of Cagliari, Cagliari, Italy


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Aim. ­Chronic ­venous ­ulcer treat­ment is ­often ­time con­suming and ­requires a ­high ­degree of com­pli­ance ­from the ­patient. ­This ­derives not ­only ­from ­venous hyper­ten­sion but ­also ­from ­chronic struc­tural and meta­bolic ­changes of under­lying tis­sues ­which ­impair the ­healing pro­cess. It there­fore ­becomes nec­es­sary to ­improve the ­ulcer ­tissue con­di­tion in ­order to accel­erate the ­healing pro­cess. ­This is ­obtained ­mainly ­with the improve­ment of ­local hae­mod­y­namics and sec­ondly by ­direct ­action on the ­ulcer. The aim of the ­study is to eval­uate the effi­cacy of a treat­ment ­with a pedun­cu­lated ­flap of ­fascia as an addi­tional treat­ment of ­chronic ­venous ­ulcer.
­Methods. ­Four ­patients clas­si­fied C6 ­according to the ­CEAP clas­sifi­ca­tion ­were ­treated for ­chronic ­venous ­ulcer ­with cor­rec­tion of ­venous hyper­ten­sion (saph­e­nec­tomy or lig­a­ture of incom­pe­tent per­fo­rating ­veins). The ­patients ­also under­went rota­tion of a fas­cial pedun­cu­lated ­flap trans­ferred ­from the ­sural ­area to the per­i­mal­le­olar ­area. ­After 7-15 ­days ­they had a ­free ­skin ­graft in the ­treated ­area.
­Results. All ­patients ­were dis­charged on the 3rd post­op­er­a­tive day ­after the ­flap rota­tion. In 3 ­patients the ­ulcer ­healed ­within 30 ­days and in a 4th ­patient ­within 45 ­days. No recur­rence was ­observed.
Con­clu­sion. ­With ­this ­method the ­healing ­time ­seems to be short­ened com­pared to the typ­ical evo­lu­tion in ­patients ­treated ­with ­only ­reflux con­trol fol­lowed by con­ser­va­tive ­therapy. Asso­ciating fas­cial ­flap in the treat­ment of ­chronic ­venous ­ulcers ­improves the bed on ­which the ­free ­skin ­graft is ­applied. We can ­also hypoth­e­size ­that ­this pro­ce­dure ­restores the apon­eu­rotic bar­rier ­between ­deep ­venous cir­cu­la­tion and super­fi­cial micro­cir­cu­la­tion ­with the ­ensuing improve­ment in ­local ­venous hyper­ten­sion.

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