New approaches to an old and vexing problem: making SEPS better

Chronic venous insufficiency (CVI) with venous hypertension and reflux causes leukocyte trapping, lipodermatosclerosis and finally skin ulceration involving the lower extremities. Perforator vein incompetence has been identified as an important contributing factor to ulceration when abnormally elevated pressure is transmitted to areas of affected skin usually at the ankle medially. A variety of surgical techniques have evolved, we describe technical modifications of Subfascial Endoscopic Surgery (SEPS) including extra fascial submalleolar perforator division and combinations of other interventions to reduce transmission of venous hypertension or reflux to affected skin areas.