CONTENTS  •  Volume 10  Number 1 1995

Study selection: A combined computerized (Medline 1980—94) and manual search of the world literature was performed.

Data extraction: All controlled trials on cutaneous wound healing were admitted. Three experimental and five clinical studies were retrieved.

Data synthesis: The experimental studies imply that cutaneous wounds treated with ultrasound heal quicker than untreated wounds. Clinical trials suggest that ultrasound speeds the healing of leg ulcers and possibly also of pressure sores -

Conclusion: Ultrasound is a promising adjunct to the complementary treatment of wounds, which would need more detailed, definitive study.

Design: Controlled study comprising patient and control groups.

Setting: Department of Surgery, University College London Medical School, London, UK.

Patients and participants: Ten patients with lipodermatosclerosis caused by chronic venous insufficiency and 10 control subjects.

Interventions: Measurements were made from the liposclerotic skin of patients and 8 cm above the medial malleolus in controls. Laser Doppler flux (LDF), blood cell velocity (BCV) and concentration of moving blood cells (CMBC) were recorded with the subject lying supine. A class II graduated compression stocking was applied to the leg and laser Doppler recordings were repeated. The protocol was repeated with the subject sitting.

Main outcome measures: The effects of a compression stocking on LDF, BCV and CMBC in the horizontal and sitting positions were measured.

Results: In patients in the supine position, the compression stocking resulted in a 28% median increase in LDF (p = 0.03), with a corresponding 29% median increase in BCV. There was no significant change in CMBC. In the sitting position, the compression stocking caused a 105% median increase in LDF (p<0.0l) due to a corresponding 89% median increase in BCV (p = 0.01); there was only 25% median increase in CMBC. The effects of compression in controls were similar to those in patients.

Conclusion: Compression stockings may be effective in the treatment of chronic venous insufficiency by increasing the microcirculatory flow velocity.

Technique: The vasa venarum were perfused with ink by reflux from the lumen of the segment. The technique worked only when the vein segment was actively constricted and its flow made turbulent.

Results: Vasa venarum were found to have the potential to drain, by unvalved channels, directly into their parent segment, into neighbouring veins, into the vasa networks of neighbouring arteries, veins and lymphatics, and into the postcapillary networks of every tissue in the hindlimb. The network contained dedicated arteriovenous anastomoses which drained by valved channels into the parent segment. A feature of the perfusion technique was the production of acute experimental varices.

Conclusions: The drainage of the vasa venarum is far more complex than it is believed to be at present. The demonstration that reflux is possible from a vein with competent valves and is associated with the production of varices may have clinical implications.

Design: Retrospective review.

Setting: Vascular unit, district general hospital.

Patients: A consecutive series of 46 patients attending with recurrent varicose veins.

Interventions: Clinical examination, hand-held Doppler, venography and varicography.

Main outcome measures: (1) Sites of incompetent venous communications. (2) Assessment of value of preoperative phlebography when compared with clinical and hand-held Doppler examination.

Results: Sixty-four venograms were performed on 46 patients of mean age 52 years, range 30-81 years. Calf perforator (88%) and mid-thigh perforator incompetence (38%) were common. Groin recurrence (33%) included examples of neovascularization, inadequate previous surgery and inadequate assessment. Popliteal recurrence (34%) secondary to incompetent gastrocnemius, popliteal fossa and short saphenous veins also present. Preoperative phlebography supplied valuable additional information in 75% of patients.

Conclusion: Phlebography of recurrent varicose veins provides useful information supplementary to that furnished from clinical examination alone.

Setting: Second Department of Surgery, Tottori University Faculty of Medicine.

Patients: Twenty normal legs, 29 legs previously affected by deep vein thrombosis and 36 legs with primary varicose veins.

Main outcome measures: The foot vein pressure was measured during ankle dorsiflexions, knee-bending and walking on the spot at 40 paces per minute during which minimum ambulatory venous pressure (AVP) and venous refilling time (VRT) were assessed.

Results: The three groups differed significantly from each other in AVP and VRT after dorsiflexion and in AVP during walking on the spot, but not after knee-bending.

Conclusion: Dorsifiexion is the most useful exercise distinguishing various seventies of venous insufficiency, but walking on the spot is more useful for accurately evaluating the calf muscle pump.

Design: Prospective study in patients and normal volunteers.

Setting: Academic Surgical Unit and Vascular Unit, St Mary’s Hospital Medical School, London, UK.

Material and methods: We prospectively examined 152 lower extremities of 150 patients with clinical suspicion of DVT. Patients were examined by APG (outflow fraction) and either ascending venography or colour flow duplex imaging (CFDI) as gold standards to establish the diagnosis. The reproducibility of outflow fraction was tested in two normal volunteers and was shown to have coefficients of variation of 6.1% and 8.2%, respectively.

Results: On venography or CFDI, DVT was detected in 96 limbs. Proximal DVT was seen in 74; it was confined to the calf in 22. APG was 95% sensitive, 95% specific and 95% accurate in detecting proximal DVT whereas it was 45% sensitive, 95% specific and 81% accurate for calf DVT.

Conclusions: Using air plethysmography, the outflow fraction is a highly reproducible and accurate measurement in detecting DVT proximal to the calf. The high positive predictive value means that if the test is positive, treatment can start immediately; if it is negative, duplex scanning is necessary to exclude proximal partially occluded thrombi or calf DVT.

Design: Comparison of disease group with control group.

Setting: Department of Medicine. Hôpital du Nord, Grenoble, France.

Subjects: Six patients (nine limbs) with lipodermatosclerosis (LDS) due to duplex-proven venous insufficiency and six controls subjects (11 limbs).

Interventions: Perfusion images were collected at rest, after venous hypertension and after skin heating.

Main outcome measures: Mean skin perfusion (mV).

Results: An increased basal flux at rest was found in liposclerotic skin (1.6 V) compared with controls (0.94, V. 95% CI = 0.16-1.48). An impairment of hyperaemic responsiveness to heat was also shown (factor of increase = 1.87 (LDS) compared with 3.28 (controls): 95% CI = 0.85-2.44).