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Phlebectomy. Technique, indications and complications.

Phlebectomy, first described by Aulus Cornelius Celsus (25 BC - 45 AD), was re-invented 40 years ago by Dr. Robert Müller, in Neuchâtel, Switzerland. This safe, esthetic, effective and economical operative technique has now been fully developed and adopted all over the world. Phlebectomy hooks enable venous extraction through minimal skin incisions (1-3 mm) or even needle punctures, assuring complete and definite eradication of the veins. The small size of the skin incisions usually results in little or no scarring, contrary to that found in classical venous surgery, and avoids the possible complications of sclerotherapy, such as skin necrosis or residual hyperpigmentation. Sites particularly appropriate for ambulatory phlebectomy include incompetent saphenous veins (except the sapheno-femoral and in most cases the sapheno-popliteal junctions), their major tributaries, perforating, groin pudendal veins, reticular veins (popliteal fold, lateral thigh and leg) and veins of the ankles and the dorsal venous network of the foot. Curettage of telangiectasias is a less well known indication, but it is also quite effective in removing networks of thick blue spider veins. Ambulatory phlebectomy of body areas, other than the legs, include dilated periorbital, temporal or frontal venous networks and venous dilatation of the abdomen, arms or dorsum of the hands. Long term results, if the indications and technique were correct, are excellent. Complications, in skillful hands, seldom occur. They may be classified as cutaneous, vascular, neurological or general and are usually benign.