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Angiology
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Surgical Treatment of Refractory Venous Stasis Ulcer Due to a Severe Impairment of Calf Muscle Pump Function: Evaluation by Air Plethysmography

A Case Report

Takaki Sugimoto, M.D.

Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

Masayoshi Okada, M.D.

Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

Masato Fukuoka, M.D.

Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

Masahisa Uematsu, M.D.

Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

Masato Yoshida, M.D.

Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

Hiromichi Toyama, M.D.

Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

The authors encountered a forty-nine-year-old man with a lower limb ulcer refractory to intensive conservative therapy. No varicose vein was found anywhere, and the usual phlebographies and foot venous pressure measurement failed to diagnose it as a venous stasis ulcer. A direct phlebography method developed by the authors, in which a thin catheter is inserted into the deep vein, disclosed a reflux of the popliteal vein or a deep muscle branch from which an incompetent perforator arose toward the superficial vein above the ulcer. Air plethysmography (APG) showed a severe impairment of the calf muscle pump function. He underwent a subfascial ligation of two incompetent perfora tors together with a stripping of the great saphenous vein passing under the ulcer. Postoperatively, this ulcer was cured in an early phase, and the calf muscle pump function showed improvement in the APG.

Angiology, Vol. 47, No. 12, 1167-1171 (1996)
DOI: 10.1177/000331979604701208
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