Minichirurgical phlebectomy (synonym: miniphlebectomy) is a surgical procedure for the removal of side branch varices (pathological enlargement of side branches of the two truncal veins of the superficial venous system). The procedure goes back to the Swiss phlebologist (“vein doctor”) Muller and for this reason is also called phlebectomy according to Muller. Miniphlebectomy is an established procedure for the treatment of varicose veins and can more than satisfy your aesthetic desires in the treatment of unsightly varicose veins. Varicose veins (lat. varix – varicose vein) are irregularly tortuous, superficial veins that may be enlarged in a nodular fashion in some areas. The removal of varices serves to prevent complications such as thrombophlebitis (inflammation of a superficial vein), variceal hemorrhage, or (in the case of long-term progression) chronic venous insufficiency with venous ulcers (ulcers). Today, this method can also be used to successfully treat the smallest varicose veins and even spider veins according to aesthetic requirements. Miniphlebectomy thus competes with sclerotherapy (sclerotherapy of varicose veins).
Indications (areas of application)
- Side branch varicosis – varicose vein formation in the side branches due to congestion of blood in the main veins.
- Reticular varicosis – phlebectasia (uniform diffuse dilatation of veins without tortuosity) in subcutaneous fat tissue.
- Spider varicosis – small reddish-bluish veins, which are usually the first sign of venous disease.
Before surgery
Before surgery, an intensive medical history discussion should be conducted that includes the patient’s medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. Note: The requirements of the explanation are stricter than usual, since courts in the field of aesthetic surgery demand a “relentless” explanation. Furthermore, you should not take acetylsalicylic acid (ASA), sleeping pills or alcohol for a period of seven to ten days before the operation. Both acetylsalicylic acid and other painkillers delay blood clotting and can lead to unwanted bleeding.Smokers should severely limit their nicotine consumption as early as four weeks before the procedure so as not to jeopardize wound healing.
The surgical procedure
The varicose veins to be removed are carefully marked with a pen after a thorough shave on the standing patient. A local anesthetic (numbing agent that is injected locally) is applied for the surgery. The surgical area is disinfected and sterilely covered. The surgeon now makes small stab incisions (1 to 2 mm long punctures (stab incisions) using microsurgical instrumentation) at the marked sites and searches out the varicose veins with small hooks or a mosquito clamp (surgical vascular clamp used to stop bleeding and as a holding device). Various surgical instrumentation may be used (e.g., Varady or Oesch). The varices are then pulled out and extracted (removed). The wounds are then dressed either with skin adhesive or with a plaster bandage. After application of a compression bandage (pressure bandage) or a compression stocking (thrombosis stocking), the patient is able to move freely as usual. The operation usually takes about one hour.
After the operation
The patient should wear the compression bandage postoperatively for about 2 weeks. A dressing change is usually done on the 2-4 day after surgery.
Possible complications
- Blue spots on the skin; swelling, tightness and a feeling of pressure in the legs, possibly also sensory disturbances. These usually disappear after a few days.
- Injury to skin nerves; this then leads to paresthesia (numbness); in rare cases, also permanent pain due to a neuroma, which is a benign nodule that can develop after severing a peripheral nerve (neurectomy) at the site of the defect.
- Strength pain, as a sign of a circulatory disorder (in this case, an immediate control examination is required)
- Wound healing disorders (rare)
- Infections (rare)
- Temporary swelling, tightness and feeling of pressure in the legs may be due to lymphatic congestion or/and hematoma (bruise).This is well treatable by compression therapy (eg compression stockings): If there is chronic lymphatic congestion, lymphatic drainage may be required.
- As after any surgical procedure, thrombosis (formation of a blood clot) may occur, with the possible consequence of embolism (occlusion of a blood vessel) and thus a pulmonary embolism (danger to life). Thrombosis prophylaxis leads to a reduction in risk.
- The use of electrical devices (e.g. electrocoagulation) can cause leakage currents, which can lead to skin and tissue damage.
- Positioning on the operating table can cause positional damage (e.g., pressure damage to soft tissues or even nerves, resulting in sensory disturbances; in rare cases, this can also lead to paralysis of the affected limb).
- In case of hypersensitivity or allergies (e.g. anesthetics/anesthetics, drugs, etc.), the following symptoms may temporarily occur: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
- Severe life-threatening complications concerning heart, circulation, breathing, etc. are very rare. Similarly, permanent damage (eg, paralysis) and life-threatening complications (eg, sepsis) are very rare.
