Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3649_Библиотеки_им_академика_М_И_Перельмана

With this technique, described well in many papers, the practitioner first marks on the leg the sites of all dilated varicosities. The patient then assumes the supine position with the leg elevated to approximately 60 degrees to empty the veins. After at least 20 seconds, or when the distended veins are flattened, the leg is gently and rapidly palpated to detect any defects in the fascia. With experience, these can be detected easily as places that allow the entrance of the examining finger without the use of any pressure. Fascial defects can be caused by many abnormalities other than perforating veins, thus the practitioner continues the examination by compressing the individual fascial defects with his or her fingers and then having the patient stand. The fingers are then released one by one, starting with the most distal defect, and rapid filling of more distal varicosities is noted (Fig. 5.7). Those defects that cause distal filling when released are assumed to correspond to sites of IPVs. In the presence of a dilated GSV or SSV, these points of reflux first must be controlled with either digital compression or a tourniquet to evaluate the lower volume reflux through the perforators. For the evaluation to be helpful, compression of the defects must first cause sustained flatten­ing of the varicosities when the patient initially stands. If the veins fill before any of the fingers are released, the test must be restarted and other sites compressed until the sites respon­sible for the reflux are located. This examination is associated with a 50% to 70% accuracy