Saphenofemoral ligation as a safe and effective alternative for the treatment of chronic venous leg ulcer

Objectives: To evaluate the effectiveness and safety of isolated saphenofemoral junction ligation for the treatment of chronic venous leg ulcer in comparison to traditional stripping procedure. Methods: Thirty six patients (28 men and 8 women) with mean age of 42.3 +/- 8.7, presented with a venous leg ulcer. After taking a full history, they underwent examination for presence of edema, cellulitis or local ulcer infection. The site and size of ulceration were recorded and ankle-brachial pressure index (ABPI) was measured. Venous color Doppler ultrasonography was performed and venous valvular incompetence was assessed using Valsalva test and calf compression. Patients were divided into 2 groups. Group I, (n=10 assigned for long saphenous stripping, while group 11, (n=26) assigned for saphenofemoral ligation and divided combined with ligation of major tributaries under local infiltration anesthesia. Mean operative time, postoperative complications and hospital stay were recorded. The study was carried out in Benha University Hospital, Egypt and Armed Forces Hospital, Khamis Mushayt, Southern Region, Kingdom of Saudi Arabia, between January 2000 and December 2001. Results: The mean operative time and the hospital stay were significantly (p<0.05) reduced in group II compared to group I. The postoperative complications were significantly (x(2)=7.5, p<0.05) reduced in group II. Ulcer healing started after 3 months in group II and 6 months in group 1, but, by 12 months, group II had a significant (x(2) =6.7, p<0.05) number of healed ulcers (n=22, 84.6\%), compared to group I (n=7, 70\%). Conclusion: The isolated ligation of saphenofemoral junction is a minimally invasive, safe and effective modality for treatment of chronic leg ulcer, and being easily performed under local anesthesia and considered to be a satisfactory procedure for treatment of leg ulcer in patients who are unfit for general anesthesia.