Study of The Comparative Efficacy of Surgical Versus Conservative Intervention in The Management of Recurrent Venous Ulcers - (Post Operative) Venous Ulcers

Abstract

Background: Recurrent venous leg ulcers after previous saphenofemoral junction ligation and great saphenous vein stripping remain difficult to manage, particularly when perforator incompetence persists. Objective: To compare six-month wound-area outcomes after conservative and surgical management of recurrent venous leg ulcers. Methods: This prospective, non-randomized comparative study included 64 patients treated at two Kasturba Medical College hospitals in Mangalore from August 2013 to August 2015. Patients selected conservative or surgical management (32 per group). All received wound care, compression, and limb elevation. The surgical group underwent treatment of incompetent perforators, with repeat saphenofemoral junction ligation when indicated. Foam sclerotherapy was recorded in 8 conservative-group patients and all 32 surgical-group patients. Wound area was assessed at baseline and at 1, 3, and 6 months. Unadjusted between-group comparisons were performed at each time point. Results: The duration of the current ulcer was longer in the conservative group than in the surgical group (15.31 ± 10.36 vs 10.16 ± 6.09 months; p = 0.009). Baseline wound area was similar (91.22 ± 80.58 vs 80.38 ± 49.78; p = 0.898). Between-group differences were not statistically significant at 1 month (81.59 ± 79.95 vs 65.81 ± 54.80; p = 0.386) or 3 months (69.84 ± 49.15 vs 59.59 ± 55.88; p = 0.209). At 6 months, mean wound area was 88.03 ± 85.48 in the conservative group and 55.72 ± 57.51 in the surgical group (p = 0.024). The conservative-group mean decreased through month 3 but increased again by month 6. Conclusion: The surgical-management group had a smaller wound area at 6 months, but the non-randomized design, baseline difference in ulcer duration, unequal use of foam sclerotherapy, and absence of a repeated-measures analysis prevent attribution of this finding to perforator ligation alone. The results should be interpreted as an association and require confirmation in a study with standardized co-interventions and longitudinal analysis.