Lateral Fasciectomy Sparing the Superficial Peroneal Nerve with Simultaneous Mesh Graft in Non-healing Lateral Leg Ulcers of Diverse Vascular Origins: Surgical Technique, Short- and Long-term Results from 44Â Legs

ObjectivesThe technique of lateral fasciectomy (LF) sparing the superficial peroneal nerve with mesh graft coverage is a novel treatment of non-healing lateral leg ulcers of various vascular origin affecting the fascia. We report short- and long-term results of LF for recalcitrant lateral leg ulcers.DesignThis study is a single center, retrospective case series of consecutive patients treated by LF.MaterialsFrom 827 ulcers treated at our institution, 44 recalcitrant lateral leg ulcers affecting the fascia (41 patients) underwent lateral fasciectomy between 2006 and 2013.MethodsPreoperative indications, step-by-step surgical procedures, and perioperative care methodologies are presented. Long-term effects of healing and recurrence were clinically investigated or obtained through telephone interviews with relatives and local practitioners.ResultsThree discrete etiologies were identified: venous ulcers (n = 24), arterial-venous/mixed ulcers (n = 11), and arteriolar Martorell hypertensive leg ulcers (n = 9). Complete healing was achieved in 40 legs (91%) after 3 months, and in 43 of the affected legs (98%) in total. The median duration to complete healing was 64 days. There was no difference between the healing times of different etiologies. No local recurrence was observed during the follow-up period, which ranged from 1.8 to 8.7 years (median: 5.11, mean: 5.12). Twelve patients (27%) died within this period due to multimorbidity.ConclusionsFollowing lateral fasciectomy and mesh graft coverage, 43 legs (98%) healed in previously treatment resistant lateral leg ulcers.