Minimization of skin incisions at stripping by Mayo of large-diameter veins.

BACKGROUND: To study the possibility of minimization of the skin incisions up to a puncture size at stripping by Mayo with the use of the stripper with an oval-ring head for large-diameter veins.

METHODS: The problem is solved due to the geometrical changing of the stripper head from a round to an oval one. The laboratory experiment showed that with a vein diameter of 10-20 mm the total cross-sectional area of its walls constituted 13.61 mm2, with a diameter of more than 20 mm it was 19.98 mm2. There were designed three types of the external dimensions for the stripper: 3.0 х 6.0 mm; 3,5 х 7.0 mm and 4.0 х 8.0 mm. From 1997 to 2017 the stripper with an oval-ring head was used in 1274 patients (male, n=421; female, n=853) for treating 1832 lower limbs. Average age was 46.4±12.3 years (range, 29 to 73). GSV and SSV stripping was performed in 1165 and 137 cases respectively in patients with the trunk diameter of more than 10 mm, severe vein tortuosity, for a vein located immediately under the skin, as well as for patients with the history of thrombophlebitis.

RESULTS: The pain level in the 1st evening after the operation was 1.59, on the 7th day it decreased to 0.12 according to VAS-10. The motion activity level in the 1st evening after the operation was 7.24, on the 7th day it decreased to 9.96 according to VAS-10. All patients had primary wound healing. Hematomas along the location of the eliminated veins were of a moderate nature and resolved, on average, within 17 days. With the GSV diameter of 10-20 mm the skin scars were of 2.93 mm (95% CI: 3.09 mm - 4.47 mm), with the GSV diameter of more than 20 mm the skin scars were of 4.10 mm (95% CI: 4.01 mm - 5.07 mm). After 3 months 1102 patients (86,5%) were very satisfied and 172 (13,5%) were just satisfied with the performed operation.

CONCLUSIONS: The use of the proposed stripper with an oval-ring head in patients with large-diameter subcutaneous trunks leads to the minimization of the skin incisions up to the punctures and, in general, makes the surgery significantly less traumatic, providing a quick recovery and minimization of the skin scars.