Tibial periosteum distraction for the treatment of lower extremity varicose vein ulcers combined with deep vein thrombosis: A case report.

RATIONALE: Lower extremity venous ulcers are highly prevalent in elderly populations. These chronic wounds often persist for extended periods, heal poorly, and frequently recur, severely compromising patients' quality of life while creating considerable socioeconomic burdens. When complicated by deep vein thrombosis, they further restrict viable treatment options. PATIENT CONCERNS: A 55-year-old man had experienced left lower extremity varicose veins for 3 months, accompanied by a recurrent 3 × 4 cm fascial-penetrating ulcer, chronic pain, superficial venous dilation, and cutaneous hyperpigmentation. Doppler ultrasound revealed left lower extremity deep vein thrombosis. DIAGNOSES: The clinical evaluation confirmed primary diagnoses of left lower limb varicose veins (Clinical-Etiology-Anatomy-Pathophysiology-6 classification) and left peripheral-type deep venous thrombosis in the lower extremity. INTERVENTIONS: The first surgery involves stripping and ligation of the superficial varicose veins at the ulcer site, in conjunction with tibial periosteum distraction. After 14 days of periosteal distraction, the distraction device was surgically removed in the second procedure. OUTCOMES: Postoperatively, the patient experienced substantial symptom relief in the affected lower extremity. Within 1 month, the ulcer formed a scab and approached healing by one and a half months. Throughout the 9-month follow-up, there was no recurrence of the ulcers, and the patient's quality of life markedly improved. LESSONS: In patients with Clinical-Etiology-Anatomy-Pathophysiology-6 varicose veins complicated by deep vein thrombosis, the combination of tibial periosteum distraction with conventional stripping and ligation of superficial varicose veins resulted in symptomatic relief, promoted ulcer healing, reduced economic burden, and improved quality of life.