ORIGINAL ARTICLE   

Acta Phlebologica 2019 December;20(3):80-3

DOI: 10.23736/S1593-232X.19.00453-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Venous leg ulcers and gastrocnemius muscle

Fernando VEGA-RASGADO ^{1, 2} ✉, Fernando CONTRERAS ^{1, 2}, Carlos ARREOLA ^{1, 2}, Felipe RENDON ^{1, 2}, Eugenio JIMÉNEZ ^{1, 2}, Lourdes A. VEGA-RASGADO ^{1, 3}, Héctor CARRIZOSA ³, J. Fernando TORRES ^{1, 2}, Blanca V. PASTRANA ^{1, 2}

¹ Mexican Institute of Phlebology (IMF), Mexico City, Mexico; ² Colegio de Médicos Cirujano J.R. Tournay, Mexico City, Mexico; ³ National School of Biological Sciences (ENCB), I.P.N., Mexico City, Mexico

BACKGROUND: Venous ulcer is traditionally considered the ultimate and most serious consequence of hypertension of chronic venous insufficiency (CVI). The main therapeutic objective is to reduce venous hypertension through the use of Compression systems as inelastic bandages and reflux suppression. Preliminary evidence shows a close relationship between the risk of ulcer development and the decreased range of motion of the ankle (RAM) and the limited efficiency of the calf pump. In the present study we evaluate the clinical effectiveness of a mini-invasive surgical release of the medial gastrocnemius tendon in patients with diminished RAM of the ankle (dorsiflexion of less than 10 degrees) and rebel venous ulcers.
METHODS: Five patients with rebel venous ulcers of 5 years on average and dorsal flexion of 10 degrees or less of the ankle were subjected to a clinical and ultrasound evaluation of the gastrocnemius veins before and after the minimally invasive surgical elongation of the medial tendon of the gastrocnemius. The study was approved by the Ethics Committee and informed consent was obtained from all patients.
RESULTS: The RAM of the ankle improved from a preoperative value of 7.4° to 24° (P=0.0001). All ulcers healed in an average time of 6.2 weeks (3-12). At 3 months of follow-up, the average diameter of the gastrocnemius veins changed from 8.9 mm to 5.82 mm (P>0.01).
CONCLUSIONS: The deterioration of the biomechanics of the lower extremities during the gait plays an important role reducing the venous drainage of the leg. Gastrocnemius veins should be better studied, and we verify that not only the venous hypertension caused by valvular insufficiency participates in the genesis of the venous ulcer, but also and very importantly the function of the gastrocnemius muscles. Elongation of gastrocnemius may be a useful method for the treatment of rebel venous ulcers.

KEY WORDS: Varicose ulcer; Skeletal muscle; Veins; Endovascular procedures