The surgical treatment of incompetent perforating veins.

Ulceration of the skin of the lower limb has been recorded as an affliction of the human race since the time of Hippocrates. It is almost certainly the price we pay for having emerged from the ocean and learned to stand erect. 1 The association between ulceration at the ankle and venous disorders of the lower limb has been known for over 2000 years and compression therapy is referred to in the Old Testament (Isaiah 1:6) and is mentioned by Hippocrates as well. z During Roman times, a number of physicians,, including Celsus and Galen, advised the use of plasters and linen bandages in the treatment of leg ulcers. 3 Until the Middle Ages, however, the philosophy of treatment of venous ulcer was dominated by Galen's black bile theory and his erroneous but influential views on venous bloodflow. Physicians attributed ulceration of the legs to the accumulation of black bile, bad humours, menstrual blood and faeculant humours and were convinced that healing of the ulcer would be catastrophic, causing "melanchol~ madness, drops~ palpitation ... and other things".4' 5 The first documented operations in the treatment of venous insufficiency were performed around 1850. 5 Madelung was the first who excised the greater saphenous vein through a long incision over the medial aspect of the leg and thigh; a formidable procedure associated with considerable morbidity and mortality. 6 In 1907, Babcock in New York devised the intraluminal stripper for the extirpation of the greater