Chapter 5: Leg Veins and Ulcers

PERCUTANEOUS LIGATION FOR THE ISOLATED VEIN

This method can be used for the cosmetically unacceptable, isolated varicose vein in the leg, as an alternative to sclerotherapy. A 3/0 polyglycolic acid (Dexon) suture is simply inserted through the skin to encircle and ligate the vein.

Equipment

You will need:

• 3/0 polyglycolic acid suture

• cutting-edge needle

• needle holder and scissors

• local anaesthetic agent.

Method

1. Infiltrate LA around the site or sites of the vein to be ligated:

   • small veins (up to 5–10 cm), a single suture

   • larger veins, multiple sutures, 5–10 cm apart.

2. Using a cutting-edge needle, pass the suture under the vein (Fig. 5.1a).

3. Bring the suture through the skin and then simply tie it tightly to occlude the vein by constriction (Fig. 5.1b). The treated vein thromboses and atrophies after a short period.

4. Review the patient in 4 weeks and remove the suture.

Precautions

Avoid areas near the dorsalis pedis artery and the common peroneal nerve, or other significant arteries, veins or nerves.

AVULSION OF THE ISOLATED VEIN

This method can be used to treat the cosmetically unacceptable isolated varicose vein in the leg. It is possible to avulse the vein using local anaesthesia along the length of the varicose vein.

Equipment

You will need:

• local anaesthetic

• no. 15 scalpel blade (and handle if not disposable)

• six small Halsted artery forceps (‘mosquitoes’)

• self-adhesive closure strips 1.2 cm (Steri-Strips), or nylon suture with cutting edge needle

• non-stick gauze dressing with wool and crepe bandage.

Method

1. Infiltrate LA along the length of varicose vein to be avulsed (up to 20 mL of 1% lignocaine can be used):

   • small vein (up to 5–10 cm): a single incision (5–10 mm) along or across the midpoint of the vein

   • larger veins: multiple incisions 5–10 cm apart, depending on the length of the varicose vein avulsed at first incision (Fig. 5.2a).

2. Locate and identify the vein using an artery forceps, ensuring that it is not a nerve. Grasp the vein with two artery forceps in parallel, then divide between the two with the scalpel (Fig. 5.2b).

3. Avulse the vein on either side by applying further forceps while pulling on the vein (Fig. 5.2c). Provided the length of the varicose vein has been infiltrated with LA, there should be no pain. Apply pressure for 2 to 3 minutes to stop bleeding once the vein has been avulsed.

4. Achieve skin closure by using either self-adhesive closure strips or suture. The suture can be removed in ...