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Use of modified 40 x 1.2-mm needle in lower extremity varicose vein surgery
(Portuguese PDF version)

Alberto C. Duque¹, Manuel Julio Cota Janeiro²

1. Professor, Universidade Gama Filho; Assistant Professor, Pontifícia Universidade Católica do Rio de Janeiro; Head of the Division of Angiology and Vascular Surgery, State Institute of Diabetes and Endocrinology (IEDE).
2. Vascular Surgeon, Clinic of Circulatory Disorders.
*Study carried out at Clínica Sorocaba in Rio de Janeiro, Brazil.

Correspondence:
Dr. Alberto C. Duque
Rua Sorocaba, 464/201
CEP 22271-110 - Rio de Janeiro - RJ
Brazil
E-mail: acduque@terra.com.br

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ABSTRACT

The authors made a small change at the tip of a 40 x 1.2 mm needle, used for small incisions in varicose vein surgery, with the aim of reducing skin scarring.

Key words: varicose veins, surgery, surgical instruments.
Palavras-chave: varizes, cirurgia, instrumentos cirúrgicos.

J Vasc Br 2003;2(3):230-231

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Varicose vein surgery is reserved for those veins that are refractory to sclerotherapy due to their larger diameter.^1,2 However, reticular veins, usually of small diameter, must be surgically removed, preferably through small skin incisions. In order to reduce the size of incisions, we first used scalpel blade no. 11 and, later on, no. 40, manufactured by Beaver (USA). Afterwards, we started to use the disposable 40 x 1.2 mm needle, which allows a small and low-cost incision, as described by Stehling et al.³ This needle makes a small incision that permits the introduction of a crochet needle no. 10 or 12 and the exposure of the small-diameter vein, as previously described.⁴

Nevertheless, we noted that some patients had keloid scars or developed round-shaped, ugly scars (Figure 1). By introducing the needle into the skin, we removed a circular skin segment, as if we were performing a microbiopsy. The result of such "circular skin excision" was a small but disturbing scar (Figures 1 and 2).

Figure 1- Rounded appearance of surgical scars after the use of the 40 x 1.2 mm needle for skin incision.

Figure 2 - Circular incision made by the 40 x 1.2 mm needle, with removal of a rounded skin segment, producing a round-shaped scar. Detail (1) showing an image of the microbiopsy made by the needle.

To circumvent this problem, we decided to compress the needle tip with a Halsted or Kelly clip. This way, the beveled needle tip was flattened, providing the necessary incision for the introduction of the crochet needle, acting as a thin scalpel blade. The resulting scar seemed to be smaller and less perceptible, and the resulting incision was also smaller (Figure 3). As the needle tip is made of a thin metal, it is easily compressed with the clip, without great effort. This can be routinely performed by the surgical technologist.

Figure 3 - Detail showing that the compression of the needle tip allows a linear skin incision, which results in a faster healing process.

REFERENCES

1. Merlo I, Brito CJ, Silva RM, Pinto-Ribeiro RS. Escleroterapia de varizes. In: Cirurgia Vascular. Brito CJ, Duque AC, Merlo I, Murilo R, Lauria VL Fº, editores. Revinter: Rio de Janeiro; 2002. p. 1066-1084.

2. Miyake H, Puech Leão LE. Tratamento cirúrgico das varizes dos membros inferiores. In: Doenças Vasculares Periféricas. Maffei FH, editor. Rio de Janeiro: Medsi; 1995. p. 980-981.

3. Stehling AP, Miguel EV. Modificação da técnica de varicectomia por microincisões. Cirurgia Vascular e Angiologia 1992;8(3):4-6.

4. Merlo I, Duque AC, Janeiro MJC. Cirurgia ambulatorial de varizes de membros inferiores. Revista de Angiologia e Cirurgia Vascular 1994;3(3):4-6.