37735 Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia

Name of the Procedure:

Ligation and Division and Complete Stripping of Long or Short Saphenous Veins with Radical Excision of Ulcer and Skin Graft and/or Interruption of Communicating Veins of Lower Leg, with Excision of Deep Fascia

Summary

This surgical procedure involves the removal of problematic veins in the leg, specifically the long or short saphenous veins. It also includes the removal of severe ulcers, grafting of skin to aid healing, and addressing underlying veins that could cause issues. This comprehensive treatment aims to improve circulation and resolve ulcers and other related symptoms.

Purpose

The procedure addresses chronic venous insufficiency, varicose veins, and severe skin ulcers in the lower leg. Its goals are to restore proper blood flow, alleviate pain and swelling, promote healing of ulcers, and prevent further complications.

Indications

• Chronic venous insufficiency
• Varicose veins causing significant discomfort
• Non-healing ulcers on the lower leg
• Symptoms include swelling, pain, skin changes, or recurrent infections
• Failed conservative treatments such as compression therapy

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments may be required, including blood thinners.
• Pre-procedure diagnostic tests include Doppler ultrasound to assess vein function and blood flow.

Procedure Description

1. The patient is positioned, and anesthesia is administered (general or regional).
2. Incisions are made in the leg to access the long or short saphenous veins.
3. The problematic veins are ligated and stripped from the leg.
4. Ulcers are excised, removing damaged skin and underlying tissue.
5. A skin graft is applied to promote healing.
6. Communicating veins are interrupted to prevent future issues.
7. Removal of deep fascia may be performed to improve outcomes.
8. Incisions are closed, and the leg is bandaged.

Duration

The procedure typically takes 2 to 3 hours.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Vascular surgeon or general surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Nerve damage
• Adverse reactions to anesthesia
• Recurrence of varicose veins or ulcers
• Delayed wound healing

Benefits

• Improved blood flow in the legs
• Alleviation of pain and swelling
• Healing of chronic ulcers
• Prevention of further venous complications
• Enhanced quality of life

Recovery

• Patients will need to keep the leg elevated and avoid strenuous activities.
• Compression bandages or stockings may be required.
• Follow-up appointments to monitor healing and success of the graft.
• Most patients can return to normal activities within 2 to 4 weeks.

Alternatives

• Conservative treatments such as compression stockings and lifestyle modifications.
• Sclerotherapy: injecting a solution to close off smaller veins.
• Endovenous thermal ablation: using heat to close off veins.
• Pros and cons of alternatives include lower risk and less invasive nature but may be less effective for severe cases.

Patient Experience

• Patients may experience some discomfort and swelling post-surgery.
• Pain management will be provided with medications.
• Early mobilization is encouraged to prevent blood clots.
• Full recovery and noticeable improvement in symptoms can be expected within a few weeks.

This guide provides a detailed overview of the procedure, its purpose, indications, and the patient experience. If you have further questions or need more information, consult with your healthcare provider.