Subfascial Endoscopic Perforator Surgery

Videoscopic Subfascial Ligation of Incompetent Venous Perforators

Subfascial Endoscopic Perforator Surgery (SEPS)

People who suffer with leg ulcers due to incompetent venous perforators may find relief and healing of their ulcer following this procedure. This Videoscopic modification of the classic "Linton Procedure" has several advantages. Most importantly, the incisions that are made are not through the area of ulceration or brawny edema and thus the wound infection rate is much lower than in the classic procedure. In addition, the surgery can often be performed in an outpatient or overnight setting.

Prior to surgery, the incompetent perforators are localized using a special ultrasound study, or if necessary a venogram.

Using spinal or general anesthesia a ¾ inch incision is made on the inside of the calf. A special instrument is inserted deep to the fascia of the leg and a large balloon is inflated with water to create a working space. The balloon is then emptied and the space is insufflated with air. The camera is inserted and the perforator veins can be seen in the space passing from superficial to deep layers. Another small incision is made in the calf for passage of another instrument. The perforator veins are carefully dissected, clips are applied and the veins are divided if necessary. All trocars are then removed and the wounds are closed. The leg is dressed with an ACE wrap.

The patient is generally sent home the same day of surgery and the ACE wrap can be removed in 48 hours. Recovery from this procedure is rapid with a return to normal function within a week. Walking is permitted throughout this recovery period and pain associated with this procedure is minimal. For those patients who present with leg ulcers, healing of these ulcers is markedly accelerated with the reduction of venous pressure subjected to the skin and ulcer area.

I welcome any comments or questions.

Steven P. Shikiar, MD, FACS email