Duplex scanning is no substitute for surgical expertise in identifying the saphenopopliteal junction: results following short saphenous vein surgery.

OBJECTIVES: Short saphenous vein (SSV) surgery carries a high risk of failure to identify the saphenopopliteal junction (SPJ). We assessed the impact of surgical expertise on anatomical outcome from SSV surgery and the role of preoperative duplex SPJ marking in improving outcome for vascular and non-vascular specialists. METHODS: A retrospective analysis identified patients (30 limbs) who had undergone SSV surgery. These were recalled for duplex scanning of the SPJ. In a prospective study, 187 limbs had preoperative duplex marking of SPJ and postoperative duplex to assess outcome. Grade of operating surgeon was recorded in both retrospective and prospective analysis. RESULTS: In both retrospective and prospective analysis, vascular specialists were significantly more likely than non-vascular specialists to correctly identify the SPJ (P < 0.0001). Preoperative SPJ marking did not improve outcome for the vascular specialist or the non-vascular specialist. CONCLUSION: Preoperative SPJ marking is no substitute for surgical expertise. Competence in SSV surgery should be assessed prior to surgeons proceeding to independent practice.

Antibiotic concentration in the exudate of venous ulcers: the prediction of ulcer healing rate.

We have designed a test to measure the local circulatory insufficiency in the base of chronic venous ulcers by measuring the concentration of Cefuroxime in the ulcer exudate following a single intravenous injection of the antibiotic at a dose of 500 mg/m2. We have studied 28 patients with 42 ulcers and shown that the concentration achieved increased with in-patient conservative treatment (P less than 0.01), decreased again on discharge from hospital if the ulcers had not healed (P less than 0.01) and correlated with observed healing rates (r = 0.72). This test may assist in the clinical management of these cases by predicting healing rates and the likely outcome of conservative treatment.