[Concealed exclusion of perforant and varicose veins of lower extremities venous insufficiency (communication II)].

The second and the third elements of surgical treatment of a varicose disease and chronic venous insufficiency by concealed exclusion of perforant and varicose subcutaneous veins are outlined. The exclusion of perforant veins of the shin is limited by the zone of Achilles (sub- and retromalleolar) cellular space in muscular channel of the lower extremity. Blunt supra- and infrafascial dissection of cellular tissue with passing there extramuscular perforant veins is performed between two incisions-punctures of the skin of internal surface of the shin at the level of 7 and 20 cm from the sole of the foot using firm ligature and Jigly's hand-saw. Because of disadvantages of Clapp's method, a modified way of putting immersed concealed ligatures on subcutaneous varicose veins is proposed. It includes the usage of the second needle with a blunt end as well as returned conducting of the ligature's end above the vein in a shape of a double loop. After tying a knot with one branch of the loop by pulling another dipping end of the ligature the dissection of the tied vein from the skin and its dislocation within its own bed is carried out. 58 patients were operated on according to this method of treatment for varicose vein disease and recanalized form of the postphlebothrombotic syndrome. Unfavorable outcome was detected in 1 patient with occlusion form of this syndrome and chronic venous insufficiency of III grade in which operative treatment was not strictly indicated.