Subfascial endoscopic perforator surgery (SEPS) is an innovative approach for treatment of chronic venous insufficiency or leg ulcers. SEPS surgically addresses the cause of the disease through an approach using 1 to 3 small incisions.


The benefits of SEPS may include a higher rate of wound healing and reduced chance of developing new ulcers -


This brochure is intended to provide you with a better understanding of SEPS. If you have questions after reading this booklet, please write them down so that your doctor or other healthcare professional can answer them for you.


Overview of the Venous System:

The venous system consists of veins that return blood from the body to the heart.  In the leg, blood normally flows from the superficial veins, which are near the surface to the perforator veins which

connect to the deep deep veins.  The deep veins return blood top the heart. 


There are valves within the venous system that ensure that blood flows in one direction to the heart and does not flow backwards.


There is also a muscle of the calf of the lower leg, the "calf muscle pump," which helps to push the blood up the legs to the heart.    



What Is A Venous Ulcer?

A venous ulcer is an open sore or wound on the surface of the skin caused by problems with the veins or venous system.  Venous ulcers usually occur on the inside of the lower leg in the ankle area. 



What Causes Venous Ulceration?

A venous ulcer can result when a valve or a calf muscle pump does not work properly and causes the blood to backflow.  This is called "reflux." Backflow causes increased pressure in the vein and surrounding tissue.  The leg becomes swollen from this increased pressure. 

Also, this pressure causes skin changes.  The skin can become discolored, darker, tight, shiny and hard.                                                 next


If an external injury, bump, or even a slight scratch affects this damaged tissue, an ulcer can form. 

An ulcer is very hard to heal because of the underlying pressure caused by swelling.  Skin changes prevent oxygen and nutrients from reaching the skin surface to help heal the ulcer. 

What Treatments Can Help Heal My Venous Ulcer?

There are several non-surgical treatments that can help reduce swelling and heal the wound including: elevation, leg positioning, stretch wraps, compression stockings and compression pumps. 


However, because these treatments do not address the underlying disease, many alternatives must be used every day for an entire lifetime.  If proper treatment is not followed strictly, the ulcer will not heal or new ulcers may develop.  There are also surgical alternatives which may help heal the wound.

What is SEPS?

SEPS is a minimally invasive surgical procedure to treat the underlying condition that causes venous ulcers.  During the SEPS procedure, abnormal perforator veins are disconnected.  Abnormal perforator veins have improperly functioning valves that can cause ulceration.  By disconnecting these abnormal veins, blood flow is redirected to healthy veins.  This improves circulation in the leg and leads to ulcer healing.

What Are The Benefits of SEPS?

By addressing the underlying cause, the SEPS procedure may:

  • Enable the ulcer to heal in a relatively short period of time (4 to 8 weeks)

  • Reduce the chance of developing new ulcers

What Happens Before Surgery?

Before the procedure, a technician may use an ultrasound machine and a marking pen to map on your leg the location of all the veins that are not working properly.                                  next


Before the procedure begins, you are given general, spinal or local anesthesia to ensure you will not feel pain during the surgery.  You and your doctor will discuss what is best for you.

What Happens During Surgery?

In a typical SEPS procedure, a small incision is made in the inside area of your leg near your knee.


A special balloon is then inserted into this incision to reach an area near the perforator veins.  The balloon is then inflated to create a space for the surgeon to operate.


After the balloon is removed, a small camera is inserted into the space created by the balloon.  This allows the surgeon to see the perforators inside the leg and operate through small incisions made in healthy skin away from ulcerated tissue. 

Another small incision is made near the first incision where other small instruments can be inserted.  These instruments are used to disconnect the perforator veins which art not functioning in order to route the blood through other veins so the blood can move freely toward the heart. 

Vein stripping is often performed in combination with SEPS to heal your venous ulcer.  If done, the vein stripping will also be performed at the same time.  Your doctor will discuss this with you prior to surgery.                                                    next


When the surgery is complete, the incisions are closed, a dressing is placed over the incisions, and a compression wrap is placed on the leg.

What Happens After Surgery?

After surgery, you will rest in the recovery room until your doctor feels you are well enough to go home.  You may receive medication to relieve any pain you may have following surgery, although pain is usually minimal.  The surgeon will remove the dressing in 2 to 4 days.  You may need to wear a wrap or compression stocking until healing is complete.  This typically occurs in 4 to 8 weeks. 

How Do I Care For The Open Wound?

The wound must be free of infection and may require some surgical cleaning and antibiotics.  Your physician or health professional will chose which types of dressing is best for the wound. 

Follow Up

It is important to see you doctor regularly for follow up. 



                                                                  to beginning     Back to Brochures