Surgical management of the post-phlebitic leg syndrome

Twenty-five patients (32 limbs) with severe retrograde ejection venous syndrome (post-phlebitic leg syndrome) were surgically treated from 1971 to 1986 using a “very complete fasciotomy” with or without other individualized procedures. Clinical data, venographic findings, operative choices, and outcome were analyzed retrospectively. The theoretic benefit of adopting this new and conceptually accurate diagnostic label and the principle of “no incompetent perforators, no ulcers” is discussed. The patients generally had been managed for 10 to 20 years with conservative neglect or operative inadequacy. With correct conceptual understanding, anatomic stratification, defined indications for surgery, and individualization of procedures, an excellent result has been obtained with a low rate of serious complications. The very complete fasciotomy should be suitable for general use in treating this difficult and controversial syndrome.