Objective: Today scientifically well founded and successful methods for surgical treatment in venous leg ulcers are available. The study-group Surgical Treatment in Venous Leg Ulcers of the German Society of Phlebologie checked by current long-term results, the use by German vascular centers and the long experience of her members the importance of the different surgical methods. The results of the conferences Wien 2005 and Berlin 2006 are summarized as a consenus document. Methods: Three therapeutical concepts in the treatment of venous leg ulcers are available: varicose vein surgery or endovenous techniques, methods including the fascia cruris (fasciotomy and fasciectomy) and shave therapy or other local treatments. Results: Varicose vein surgery and endovenous techniques are suited to eliminate primary or secondary varicose veins. Currently, the indication for treatments of incompetent perforator veins changes. In Germany only 0.8% are managed by SEPS. Fasciotomy is declining too. Shave-therapy in treatment of non-healing leg ulcers shows good long-term results. Fasciectomy is reserved for special indications (deep transfascial necrosis, failure of shave therapy). Conclusion: The repertoire of surgical treatments in the therapy of venous leg ulcers is sufficient. Importance and indication of the different methods are changing.
