ABSTRACT
Introduction: Varicose veins of the lower extremities are one of the most common peripheral vascular diseases. A variety of treatments methods have emerged as an alternative to traditional surgery but are limited by their need for equipment and expertise which increases the cost of treatment making it unviable especially in rural India. Thus traditional surgery still forms the mainstay of treatment. Aims: To evaluate and compare the outcomes in patients undergoing Trendelenberg’s procedure with stripping and without stripping of varicose veins. Materials and methods: The study comprised of 50 patients who were admitted with varicose veins. They were allocated into two groups of 25 each where they either underwent Trendelenberg’s procedure with stripping or without stripping of varicose veins. The patients were followed up for six months to assess the efficacy of the procedure as per the parameters of the study. Results were analyzed using SPSS software. Percentages and proportions were used for qualitative data; mean and standard deviation were used for quantitative data. Chisquare test and student t test were applied where appropriate. Results: In the group undergoing stripping, 28% (7 of 25) patients developed hematoma, post operative pain scores on day 0,3,7 and 10 were 3.8±0.9, 2.6±0.7, 1.1±0.6 and 0.2±0.4 respectively. Mean post operative ambulation was achieved on 3.88 days and recurrence at 6 months was seen in 12% (3 of 25) patients. In the group undergoing ligation alone, 4% (1 of 25) patients developed hematoma, post operative pain scores on day 0,3,7 and 10 were 3.0±0.8, 1.6±0.8, 0.8±0.5 and 0.1±0.3 respectively. Mean post op ambulation was achieved on 2.16 days and recurrence at 6 months was seen in 20% (5 of 25) patients. Conclusions: With lesser rates of hematoma formation, better post operative pain scores and quicker ambulation in patients undergong ligation of veins alone, we conclude that Trendelenberg’s procedure without stripping is a better procedure than Trendelenberg’s procedure with stripping of veins in the treatment of varicose veins.
ABSTRACT
Background: Split skin grafting is widely used surgical procedure for the treatment of ulcers. Graft survival depends on number of factors like vascularity, wound infection etc, diabetes is associated with endothelial dysfunction, neuropathy, wound infection which collectively affect the graft survival. Objective of this study was to compare the amount of graft uptake, the post-operative complications and survival of split thickness skin graft in diabetic and non-diabetic ulcer.Methods: In our prospective comparative study total 112 patients with ulcer were included of which 56 were diabetic and 56 were non-diabetic. All of them underwent split skin grafting as part of their wound management. Comparison was made between two groups in terms of amount of graft uptake, post-operative wound infection, revisional surgery, donor site infection.Results: Compared with non-diabetics, diabetics have significantly less graft uptake (p<0.001). out of 56 patients in diabetic group 4 (66.7%) underwent revisional surgery, out of 56 patients in non-diabetic group 2 (33.3) patients underwent revisional surgery (p value is <0.68) which is statistically insignificant. 3 (60%) out of 56 in diabetic group developed post-operative graft infection, 2 (40%) out of 56 in non-diabetic group developed graft infection (p=1, not significant). One patient in the study developed donor site infection. Among 112 cases, only 1 case had donor site infection with diabetic.Conclusions: Diabetes is associated with poor graft uptake and post-operative complication rates in patients undergoing split skin grafting.