ABSTRACT
Leg ulcers caused by chronic venous insufficiency are a widespread, though often underestimated problem. Approximately 0.5% of the populations of the USA and the UK have chronic venous insufficiency,1 with an estimated loss of 2 million work days per year in the USA.2 At the turn of this century John Homans elegantly described the pathophysiological interactions of the deep, superficial and communicating venous systems.3 Linton devised an operation to interrupt the incompetent perforating veins.4 Although healing of venous ulcers after ligation of the perforating veins has been reported, the original procedure as described by Linton is seldom performed today. The main reasons for this technique being abandoned were frequent wound complications and a need for prolonged hospitalization because of the long skin incision necessary to ligate the perforators. Other researchers have developed alternate procedures that use shorter skin incisions and avoid incisions in the area of stasis dermatitis and underlying lipodermatosclerosis.5-7 Edwards8 recommended that a shearing instrument be passed blindly in the subfascial plane to interrupt the perforating veins.
