Helpful Information
Circulatory Disorders
Various diseases of the arteries (arteries)
Leg arteries
Ultrasound diagnostics of arterial circulatory disorders
Pressure measurement on the legs and determination of the ABI (Ankle-Brachial Index)
Conservative therapy of arterial circulatory disorders
Surgical therapy (bypasses, vessel dilation, stent implantations)
Diagnosis and therapy of Diabetic Foot Syndrome
Stroke
Ultrasound examination of the vessels supplying the brain
Measurement of the vessel wall thickness (intima-media thickness) to estimate the risk of stroke
Radiological interventional therapy
Carotid (carotid artery) operations
Vascular dilations (Aneurysm)
Ultrasound examination of the abdominal and pelvic arteries
Stent implantations to exclude an abdominal aortic aneurysm (EVAR method)
Minimally Invasive Procedures
The general term for surgical procedures with the smallest trauma to the skin, soft tissues, and tissue. Terms like endoscopy, laparoscopy (abdominal endoscopy), and minimally invasive surgery (MIS) are used synonymously. In many areas, minimally invasive surgery has become established and has replaced conventional procedures (large incisions). Outstanding advantages of microsurgical procedures are significantly less discomfort and a faster recovery and mobilization after the surgical procedure. The complication rates, especially the infection rate, are significantly reduced. Due to the lower postoperative pain and rapid recovery, these procedures can increasingly be performed on an outpatient basis.
Abdominal Wall Rupture or Abdominal Wall Hernia
An abdominal wall hernia is a sac-like protrusion of the peritoneum through a congenital or acquired weak point in the abdominal wall. Congenital weak points of the abdominal wall are the muscle-free areas at the navel, in the midline, and in the groin. Acquired weak points are often found in the area of scar tissue after abdominal surgery. For various reasons, the connective or scar tissue can tear. The peritoneum with the hernia contents then protrudes more or less strongly into the abdominal wall, which can be felt as a bulge. Any abdominal organ can become part of the hernia contents, but it is often the intestine. The hernia can usually be pushed back with light pressure, especially when lying down. The great danger of abdominal wall hernias is incarceration with interruption of the blood supply to the internal intestine, which can lead to a life-threatening situation within a short time. Since the risk of incarceration often cannot be reliably estimated in advance, surgery is recommended.
Inguinal Hernia
The inguinal hernia is by far the most common type of hernia. In Germany, about 250,000 inguinal hernias are operated on each year. Men are primarily affected. The hernia occurs in the area of an anatomical weak point in a muscle-free area above the inguinal ligament. A distinction is made between different forms (indirect, direct inguinal hernia, scrotal hernia), which differ in location and extent.
A special form is the soft groin or sportsman’s groin.
The main symptom of the hernia is the often painless bulge in the groin region, which becomes more prominent especially when pressing and coughing. The hernia consists of a hernia sac (peritoneum) and the hernia contents (intestine). The most common complication is the incarceration of parts of the intestine, which can lead to a life-threatening situation within a short time due to the interruption of the blood supply. Since this risk often cannot be estimated in advance, surgery is generally recommended for any hernia size. Surgery is the only permanent treatment for the hernia. The goal is to repair the destroyed tissue and, if necessary, to reinforce it. Since the results of the previously performed suture techniques were rather poor to very poor in terms of recurrence, the practice of stabilizing the groin with a mesh was adopted early on. In adults, mesh procedures have become established, also thanks to the development of non-irritating and very well-tolerated plastic meshes. The mesh can now be inserted to reinforce the abdominal wall in various ways. Basically, the procedures differ in the type of access. In conventional procedures, the mesh is inserted through an incision in the groin.
In minimally invasive procedures, a plastic mesh is inserted through very small access points at the navel and lower abdomen. The long-term results are equally good for both procedures with a low recurrence rate. The advantages of minimally invasive access are outstanding, with a significantly shorter recovery time (earlier mobilization and full weight-bearing) and significantly reduced postoperative discomfort. The individual assessment and recommendation by the doctor are crucial in selecting the procedure. Sometimes the microsurgical procedure cannot be recommended or performed, depending on the patient’s age and health condition and the size of the hernia.
Minimally Invasive Procedures
TEP Technique (Total Extraperitoneal Technique): In this procedure, which we prefer, the space behind the muscles on the peritoneum is exposed through an approx. 1 cm long skin incision below the navel. Using the peritoneum as a guide rail, i.e., still outside the actual abdominal cavity, a balloon is first pushed into the affected groin. By inflating it, the peritoneum is pushed back, thus creating a cavity that is kept open with CO2 gas via an inserted camera port after the balloon is removed. A rod-shaped optic is inserted through this access, making it possible to transmit the surgical field to a screen. In the lower abdomen, 2 additional small working ports (diameter 5mm) are inserted. With special instruments, the space is then prepared so that a 15×10 cm plastic mesh can be placed in the groin. The size of the mesh is necessary to sufficiently cover all possible hernia gaps in the groin with the mesh to counteract the risk of recurrence. The space is deflated while checking the position of the mesh. Due to the always higher intra-abdominal pressure, the peritoneum is pressed against the mesh and abdominal wall, thus immediately stabilizing the position of the mesh. Slipping of the mesh after surgery is thus almost impossible. Only in rare cases does the mesh need to be fixed, e.g., in very large hernias. Due to the low surgical trauma, the patient is quickly free of complaints and mobile. Full weight-bearing is possible after 14 days. Another advantage of the method is that bilateral inguinal hernias and sterilizations can be treated and performed in one session.
TAPP Technique (Transabdominal Preperitoneal Patch Plasty): The instrumentation is the same as in the TEP technique. The difference is the access route. Also via an incision at the navel, the camera port and the working ports are inserted into the abdominal cavity in the TAPP technique, and the groin is supplied with a mesh from the abdominal cavity. The results of the method are similar to those of the TEP technique. During the procedure, the visible organs of the abdominal cavity can also be assessed. The disadvantage of the method is the slightly increased risk of injury to organs of the abdominal cavity.
Open Mesh Procedures
Lichtenstein Operation: In some cases, open or conventional procedures are still preferable today. For example, for:
Hernias with large hernia gaps
Scrotal hernias (hernias extending into the scrotum)
Increased risk for general anesthesia In these cases, we repair the hernia using the Lichtenstein technique. An approx. 8 cm long incision is made in the affected groin. The anterior wall of the inguinal canal is opened. The hernia sac is detached from the spermatic cord. The hernia contents are pushed back into the abdominal cavity, and the hernia gap is initially loosely closed with sutures. Then, a sufficiently large plastic mesh is placed on the outside, which also sufficiently covers all other possible hernia gaps.
Suture Procedures
Pure suture procedures, e.g., according to Shouldice and Bassini, are now only performed on children or the Minimal Repair for sportsman’s groin. Here, the torn tissue is sutured in a special suture technique via a groin incision.
Sportsman’s Groin or Soft Groin
The sportsman’s groin often develops insidiously with groin complaints that intensify, especially under physical exertion. Often, the complaints do not completely subside even after a break from sports and are usually resistant to conservative therapy.
Development The soft groin occurs in all sports but is significantly more common in soccer players. According to the latest findings, there is a mismatch between the strongly developed thigh muscles and the often weaker abdominal muscles, especially in soccer. This leads to a weakening of a muscle-free area in the inguinal canal and a change in the statics of the pelvis. Under stress, this leads to nerve irritation in the area where the spermatic cord passes through the abdominal wall, which triggers the symptoms. The change in statics in the pelvic area caused by the muscle imbalance often also leads to tendon inflammation in the muscle insertion area. Thus, irritations and inflammations of the pubic bone often occur together with the soft groin.
If groin complaints do not respond to appropriate measures such as pain therapy (anti-inflammatory drugs, infiltrations), cooling, physical therapy, and a break from sports, a surgeon should be consulted early. Here, the diagnosis is made through a special physical examination and by specifically assessing the symptoms. A local pressure pain in the area of the external inguinal ring and the pubic bone when pressing is typical. A real bulge, as in an inguinal hernia, is rarely detectable. It is noteworthy, according to the latest studies, which also corresponds to our experience, that a high proportion of hernias are actually found during the surgical procedure (up to 90%), which could not be detected before the operation in a large number of cases. For typical groin complaints that do not improve with 4 weeks of conservative therapy, we recommend surgery. The decisive factor in the operation is the stabilization of the posterior wall of the inguinal canal. To keep the recovery time as short as possible, in our opinion, 2 procedures are suitable, which allow for a return to sports after 2-4 days and full physical exertion after about 14 days.
Minimal Repair: Here, the torn tissue or the hernia gap is exposed via a small groin incision and closed with a suture. The affected nerve is exposed and mobilized, sometimes repositioned or even severed. To remedy the often accompanying irritation or inflammation of the pubic bone, a special relief suture of the muscles in this area is also performed.
TEP Technique: The TEP technique has already been described in the chapter on inguinal hernias. Here, a plastic mesh is placed in the area of the posterior wall using a minimally invasive technique. The results of both methods are almost equally good; patients become complaint-free in 95% of cases quickly. In summary, the term soft groin or sportsman’s groin often hides an unrecognized inguinal hernia. If the pain cannot be treated with appropriate measures in a short time, surgery should be performed. The decisive factor in the chosen surgical method is the stabilization of the posterior wall of the inguinal canal. Suitable procedures lead to freedom from complaints in up to 95% of cases in the literature and in our own data.
Umbilical Hernia
This type of hernia occurs in the umbilical region. They can be tiny to the size of a head. The hernia sac usually contains parts of the omentum, and in large hernias, also parts of the intestine. As with all hernias, there is a risk of incarceration, sometimes associated with severe pain. This also results in the general need for surgery in adulthood. As with the operation of inguinal hernias, there are suture procedures, mesh procedures, and minimally invasive procedures. Suture procedures are suitable for small hernias. Here, if the conditions are sufficiently stable, the hernia gap is closed in a special suture technique after exposing and pushing back the hernia into the abdominal cavity. For larger hernias, plastic meshes are inserted to reinforce the abdominal wall, which additionally stabilizes the abdominal wall. These can be inserted via an access point above or below the navel or minimally invasively via laparoscopy, in the so-called IPOM technique.
Epigastric or Midline Hernias
This type of hernia occurs in the midline of the abdomen between the navel and the rib cage. The size, complaints, complications, and surgical procedures correspond to those of umbilical hernias.
Incisional Hernias
Hernias relatively frequently occur in the area of abdominal wall scars after a previous operation. The possible causes, e.g., an unfavorable incision, emergency operations, and obesity, are diverse. Whether an incisional hernia needs to be operated on should always be decided individually. All previous forms of operation are very demanding for the surgeon due to adhesions and the often large hernias. The complication rate, especially the infection rate, is also increased compared to other hernia operations. But here too, it has been possible to significantly reduce the surgical trauma and the complication rate through minimally invasive procedures and the new development of special meshes.
IPOM Technique (Intraperitoneal Onlay Mesh Technique): Here, usually 3 ports for the camera and working instruments are inserted into the abdominal cavity far from the hernia. The hernia gap is exposed from the inside, and possible adhesions are released. A specially coated mesh is then placed on the abdominal wall from the inside with a sufficiently wide overlap of the hernia gap and fixed with special tacks and sutures. The great advantage of this procedure over the open procedure is the significantly lower surgical trauma, the lower infection rate, the significantly reduced pain after the operation, and thus the faster mobilization.
“Pit Picking” Surgical Method for a Pilonidal Sinus or Coccygeal Fistula
The pilonidal sinus (pilus=hair, nidus=nest) is an acute or chronic inflammation in the subcutaneous fatty tissue, predominantly in the area above the coccygeal region. The disease has nothing to do with the actual coccyx; the fistulas are merely located over this bone.
Signs of a pilonidal fistula are sudden onset of pain, swelling, or redness at the coccyx; in addition, the area is very sensitive to pressure, which often makes long periods of sitting or walking painful. In the mild form, the inflammation is inconspicuous, without the painful symptoms. Only a small skin opening in the gluteal cleft is visible. In acute inflammations, pus formation, an abscess, occurs. The pilonidal sinus or coccygeal fistula is a disease that can develop over the course of life, primarily in puberty, with possible genetic inheritance. Men are affected twice as often as women.
The development seems to be based on various causes, triggered by the following mechanisms. Through rubbing movements of the gluteal cleft, broken hairs with root-near ends turn into the skin. This creates so-called pori or pits (depressions), which can contain hair. Since the horn scales of the hair act as barbs, the hair penetrates ever deeper into the subcutaneous tissue. There, a foreign body inflammation develops, which does not heal spontaneously but can become infected.
Strong hair growth, obesity, excessive sweating, and predominantly sedentary activity favor the development of a pilonidal sinus. The common treatment of the coccygeal fistula is via the traditional surgical method, where the entire fistula area is excised, followed by open wound treatment. The open healing of the wound is lengthy and often takes 1.5-3 months. A special form of open wound treatment for pilonidal sinus is the surgical method developed in the 1980s by the American surgeon J. Bascom.
This method is suitable for small, first-time fistula pores: the so-called “pit picking” method, which means “picking out the fistulas.” Here, only the places where hair bores into the skin (“pits”) are sparingly excised. The “pit picking” operation is the smallest procedure for the treatment of patients with a coccygeal abscess. This procedure is usually performed on an outpatient basis, in the prone position, and under general anesthesia.
The principle of this surgical technique is to narrowly excise (“pick”) the existing fistula tracts in the anal cleft (the “pits”), with wounds of only 2 to 3 mm. This achieves a closure of the fistulas through scarring. If the “pits” close, the formerly inflamed cavity under the skin also sticks together and heals. After the operation, there are no restrictions. The dressing can be removed the next day; after that, it is sufficient to wear an insert with compresses on the wound surface. Rinsing and ointments should be avoided. Support for the healing process through analgesics and a recovery phase is advisable. The procedure has a recurrence rate of about 20% in men, but only about 4% in women, so the procedure is almost ideal for female patients. The recurrence rate is slightly higher in men, but due to the gentle initial operation, the “pit picking” method can be repeated without problems, even as often as desired, in case of a recurrence.
“Smoking and obesity increase the risk of recurrence.”
Overall, the fistulas heal completely after a “pit picking” operation after a maximum of 4 weeks, and the surgical area is completely dry.
Thyroid Gland
More Safety in Thyroid Surgery through Neurostimulation A new procedure was introduced at Meliva MVZ Westpfalz that significantly increases safety in thyroid operations. With more than 100,000 procedures, operations on the thyroid gland are among the most common surgical procedures in Germany alone. A possible complication of thyroid surgery is injury to the vocal cord nerve. This nerve runs variably in the immediate vicinity of the thyroid gland. The frequency of injury to the vocal cord nerve is reported in the literature as 0.5 – 7.0% on one side and 0.5 – 2.0% on both sides. Consequences of the injury include hoarseness and shortness of breath, as well as life-threatening situations that require an emergency tracheotomy. To avoid such complications, careful preparation and nerve visualization have been standard practice. Increasing safety is now ensured by nerve stimulation and the derivation of so-called action potentials of the nerve. Through this so-called neuromonitoring, the endangered vocal cord nerve can be easily identified and its function monitored throughout the entire operation. The “Avalanche” neurostimulation device from the company Langer has already been used successfully several times by Dr. Jung. Quote from Dr. Jung: “A simple method that significantly improves safety for patients and surgeons.”
Offers and Services
Thyroid consultation by appointment, certified in the German Thyroid Center
Thyroid and parathyroid diagnostics
Laboratory tests
Ultrasound examinations
Thyroid and parathyroid operations
The Swollen Leg
The causes of a swollen leg are diverse and often affect several organ systems. In addition to diseases of the heart, kidneys, liver, and metabolism, the following diseases can also cause an increase in the circumference of the legs:
Varicose Vein Disease Varicose vein disease (medically varicosity or varix) is a common ailment. In 90% of those affected, there is a hereditary predisposition. Symptoms of varicose vein disease are:
Heavy, tired legs
Feeling of tension
Swelling of the lower legs and ankles
Rarely, nocturnal cramps and a feeling of restlessness in the legs Complications of varicose vein disease are:
Nutritional disorders of the skin due to chronic congestion with brownish discoloration up to an open leg (ulcus cruris, end stage of the disease)
Phlebitis (vein inflammation)
Thromboses
Bleeding from bursting varicose veins
Lower Leg Ulcer (Ulcus cruris) A lower leg ulcer can be the result of varicose vein disease or post-thrombotic syndrome (PTS). It often occurs above the inner ankle. In the course of the disease, considerable pain, swelling, severe inflammation, and hardening of the muscle sheath (fascial sclerosis) can develop. Treatment options:
structured wound care
compression therapy
movement
growth factors
surgically, e.g., by varicose vein removal, longitudinal splitting of the muscle sheath (fasciotomy), and removal of dead tissue For long-standing ulcers, a tissue sample should also be taken to rule out malignant skin diseases as a cause.
Lymphedema This disease often still leads a shadowy existence in medical practices and is often diagnosed and treated too late, and the therapeutic possibilities are not exhausted. Lymphedema is a mostly chronic transport disorder of the lymph from the tissue. The causes are diverse, sometimes also unclear. The disease often affects women and often begins insidiously at a young age. After diagnosis, an individual therapy concept is designed for the patient. Often, long-term treatment is necessary. The cornerstones of therapy are decongestion therapy through lymphatic drainage and maintenance therapy through compression. The earlier the treatment begins, the greater the chances of success.
Lipedema Lipedema is a mostly hereditary, chronic fat distribution disorder, with the disease occurring almost exclusively in women. In addition, there is often also a lymphedema. This is then called a lipo-lymphedema. As with lymphedema, long-term therapy consisting of decongestion and compression therapy is often necessary. In very severe cases, liposuction can also be considered. It is important to know that lipedema is not an expression of being overweight and therefore cannot be treated by diet.
Diagnosis and Therapy of Venous Thromboses and Phlebitis
We tie health to your leg A thrombosis is a blood clot in the deep venous system. If this blood clot forms in the superficial system, it is called phlebitis (thrombophlebitis). Thromboses often occur suddenly; the causes are diverse, sometimes also unclear. The thrombosis should be diagnosed quickly to prevent possible complications, such as the life-threatening pulmonary embolism and post-thrombotic syndrome (PTS), a lifelong secondary disease. Through ultrasound examination, it is now possible to reliably detect a thrombosis of the deep and superficial leg and arm venous system. For thromboses in the pelvic area, an additional computed tomography of the affected region is sometimes necessary. If the doctor diagnoses a thrombosis or thrombophlebitis, immediate differentiated treatment is necessary. To prevent the blood clot (thrombus) from growing or parts of it from breaking off (risk of pulmonary embolism), blood clotting is usually inhibited with heparin. This is done with abdominal injections 1-2 times a day. Regular checks of the blood count are important here, as a significant drop in platelets (thrombocytes), the so-called HIT syndrome, can occur in a few people. In the further course, a longer-lasting anticoagulation is necessary. For a first thrombosis, usually 3-6 months, because during this time, the coagulability of the blood, and thus the risk of a new thrombosis, is increased due to the remodeling and breakdown of the blood clot. This so-called secondary prophylaxis is now usually carried out with coumarin (e.g., Marcumar) in tablet form. Taking coumarins requires regular blood tests and special attention, as bleeding can occur if the dosage is too high. Compression is just as important as inhibiting blood clotting. Initially, this presses the blood clot against the vein wall, and it can grow together with it. In addition, the rest of the venous system is supported to take over the function of the closed vein. Later, sequelae such as post-thrombotic syndrome are mitigated or prevented. The length of the compression therapy depends on the extent of the thrombosis and the sequelae. The required period is discussed between the doctor and patient during the course of treatment and determined individually. According to the latest studies, immobilization (bed rest) and thus hospitalization are only necessary in the rarest of cases. Ultrasound follow-up examinations are necessary at initially close intervals. The patient is cared for during this time by our vein center and the family doctor.
Compression Therapy
For many diseases of the legs, compression therapy is essential. This is sometimes limited in time, sometimes permanently necessary. A common cause of diseases of the venous and lymphatic vessels is a transport disorder, where the vessels are no longer able to transport themselves. The goal of compression therapy is now to narrow the vessels through permanent pressure and thus increase the flow velocity of the blood. This reduces the tissue pressure and transports away waste products. This leads to a significant reduction in complaints.
Compression reduces complaints and increases quality of life Compression therapy is used to treat a variety of leg diseases:
Thrombosis and phlebitis (thrombophlebitis)
Post-thrombotic syndrome
Lymphedema and lipedema
Temporary follow-up treatment for varicose vein operations
Pregnancy edemas An individual therapy concept is important. The inclusion of symptoms, the patient’s age, and the patient’s mobility are just as important as the compression class, the type of stocking, and the manufacturing process. An off-the-shelf stocking is not suitable for treatment! For successful compression therapy, the doctor will prescribe the appropriate stocking for the patient, whereby the advice of an authorized specialist dealer is just as important.
Varicose Vein Operations
Outpatient and inpatient varicose vein operations in microsurgical technique Through the further development of surgical instruments and surgical technique, it is now possible to operate on varicose veins gently and with few complications. As a result, many varicose vein operations can be performed on an outpatient basis. Depending on the severity and the accompanying diseases, however, inpatient treatment for 2-3 days is sometimes necessary and sensible. The classic varicose vein operation is the so-called stripping procedure. Here, a probe is inserted into the main varicose vein via a small groin incision and guided out in the area of the lower leg. The probe is then pulled out together with the entire varicose vein (stripped). In the same session, diseased side branches are removed through very small skin punctures (miniphlebectomy technique). As a rule, a drain is inserted into the stripping canal from the groin. The leg is wrapped until the first dressing change after 1-2 days and then supplied with a compression stocking for 4 weeks. The compression stocking should also be worn overnight for the first 5 days. The sutures are removed on the 4th and 8th day after the operation. Since the risk of thrombosis (blood clot in the deep leg vein system) and embolism (displacement of clots into the lungs) is slightly increased in leg operations compared to other operations, we prescribe heparin therapy via abdominal injections for 10 days. The surgical procedure has very few complications, and the cosmetic and long-term results are very good. Superficial hematomas typical of the operation resolve completely. If the operation is performed correctly, re-interventions are very rare. The goal of the operation is to treat the symptoms and complications of varicose vein disease. Since the formation of varicose veins is hereditary and not actually curable, varicose veins can develop again elsewhere. However, these are usually of no medical significance and often only a cosmetic problem that is easily accessible through sclerotherapy. The patient’s individual treatment plan is created in a consultation. The required prescriptions (compression bandages, stockings, thrombosis injections) are issued, and the surgery date and follow-up appointments are set. Intensive care by the practice team is always guaranteed before, during, and after the operation. In addition to the practice number, the patient also receives a telephone number where the surgeon can be reached at any time. It is important that the patient feels well cared for and safe before, during, and after the operation.
Foam Sclerotherapy of Larger Veins
In foam sclerotherapy, the sclerosing agent is foamed using a special procedure. As with liquid sclerotherapy, the foam leads to a destruction of the inner wall of the vessel. Since the foam adheres to the vessel wall for a longer time, it is also possible to sclerose larger vein branches with very good results.
Thermocoagulation
New gentle procedure for the treatment of spider veins, skin changes, and varicose veins. A new procedure has been introduced that makes it possible to treat vascular changes in a gentle way. The manufacturer has succeeded in developing a device with which both spider veins and various skin changes, as well as varicose vein diseases, can be treated gently. The demanding results are permanent and visible immediately after the treatment. The method is free of undesirable risks and side effects. In this procedure, problem vessels are sclerosed. The principle of this sclerotherapy (thermocoagulation) is to cause the protein in the blood and vessel wall to coagulate (coagulate) precisely through heat impulses alone. The coagulated blood is then naturally broken down by the body’s metabolism. The heat causes no discomfort during the treatment.
Varicose Veins (Varicosity) In sclerotherapy, a medication is injected into the spider veins, which leads to a destruction of the inner wall of the vessel and thus to the closure of the vessel. The treatment is almost painless due to the very fine injection needles. At the beginning of the treatment, injections are started at a low dosage to test the individual reaction to the agent. This also allows the success of further sclerotherapies to be well estimated. Sometimes the sclerosing agent triggers blood clotting, which means that the spider veins are still visible for some time and only fade over time. After the injection, an inflammation can develop in very superficially located spider veins, which, however, quickly subsides with appropriate therapy with moist, cool compresses. Liquid sclerotherapy is a procedure that has been tried and tested millions of times, is low in pain and side effects, and with which a very good cosmetic result can usually be achieved.
Spider Veins Spider veins are small, dilated blood vessels on the legs that are visible as light red vascular trees, dark blue veins, or reddish fields. Spider veins usually develop due to a predisposition and are often the first expression of venous weakness. If nothing is done here, threatening-looking varicose veins can develop. Through thermocoagulation, the annoying veins can be permanently and painlessly sclerosed in one to three treatments. This is done without the addition of chemicals, only through the action of heat. The skin remains unharmed. Micro-crusts that are visible the next day dissolve on their own. The vessel remains permanently gone. No compression stocking is required after the treatment. You can then go about your daily life as usual and even do sports. Spider veins are small, dilated blood vessels on the legs that are visible as light red vascular trees. The method is almost painless compared to laser treatment and is suitable for every skin type. Advantages compared to other methods such as liquid sclerotherapy and laser:
no pigmentation disorders
no burns or bruises
no scarring
suitable for all skin types
possible at any time of the year
no compression required
immediate physical activity possible.
Spider Nevi Also known as spider angiomas or vascular spiders, “spider nevi” are small new formations of blood vessels. Fine, star-shaped veins emerge from a central vascular nodule. They can occur at any age and on any part of the body. Removal by thermocoagulation is painless and usually possible in a single short session. The result is immediately visible.
Dilated Veins (Couperose) These are fine red blood vessels that are clearly visible on the skin. They occur particularly frequently on the face after many years of exposure to the sun and weather. However, a hereditary predisposition and stress are also likely causes. In just one session, the complete removal of individual veins is possible without problems and painlessly. In cases of massive occurrence, a significant cosmetic improvement can be achieved.
Cherry Angiomas These are pinhead to lentil-sized red spots or small nodules that consist of dilated small blood vessels and can occur anywhere on the body. They are not dangerous but are cosmetically disturbing and often make those affected look older than they feel. Through thermocoagulation, these can disappear quickly and painlessly forever.
Ultrasound Diagnostics
High-resolution ultrasound devices are indispensable in a modern vein practice. This allows us to make a clear diagnosis quickly and without burdening the patient. After the ultrasound examination, no further additional examinations are usually necessary. After describing the complaints and the physical examination, an ultrasound examination is performed, which takes 10-15 minutes per leg. Afterward, the diagnosis and the therapy concept are discussed in detail with the patient.
“Pit Picking” Surgical Method
For a Pilonidal Sinus or Coccygeal Fistula The pilonidal sinus (pilus=hair, nidus=nest) is an acute or chronic inflammation in the subcutaneous fatty tissue, predominantly in the area above the coccygeal region. The disease has nothing to do with the actual coccyx; the fistulas are merely located over this bone. Signs of a pilonidal fistula are sudden onset of pain, swelling, or redness at the coccyx; in addition, the area is very sensitive to pressure, which often makes long periods of sitting or walking painful. In the mild form, the inflammation is inconspicuous, without the painful symptoms. Only a small skin opening in the gluteal cleft is visible. In acute inflammations, pus formation, an abscess, occurs. The pilonidal sinus or coccygeal fistula is a disease that can develop over the course of life, primarily in puberty, with possible genetic inheritance. Men are affected twice as often as women. The development seems to be based on various causes, triggered by the following mechanisms. Through rubbing movements of the gluteal cleft, broken hairs with root-near ends turn into the skin. This creates so-called pori or pits (depressions), which can contain hair. Since the horn scales of the hair act as barbs, the hair penetrates ever deeper into the subcutaneous tissue. There, a foreign body inflammation develops, which does not heal spontaneously but can become infected. Strong hair growth, obesity, excessive sweating, and predominantly sedentary activity favor the development of a pilonidal sinus. The common treatment of the coccygeal fistula is via the traditional surgical method, where the entire fistula area is excised, followed by open wound treatment. The open healing of the wound is lengthy and often takes 1.5-3 months. A special form of open wound treatment for pilonidal sinus is the surgical method developed in the 1980s by the American surgeon J. Bascom. This method is suitable for small, first-time fistula pores: the so-called “pit picking” method, which means “picking out the fistulas.” Here, only the places where hair bores into the skin (“pits”) are sparingly excised. The “pit picking” operation is the smallest procedure for the treatment of patients with a coccygeal abscess. This procedure is usually performed on an outpatient basis, in the prone position, and under local anesthesia, and in special cases, also under general anesthesia. The principle of this surgical technique is to narrowly excise (“pick”) the existing fistula tracts in the anal cleft (the “pits”), with wounds of only 2 to 3 mm. This achieves a closure of the fistulas through scarring. If the “pits” close, the formerly inflamed cavity under the skin also sticks together and heals. After the operation, there are no restrictions. The dressing can be removed the next day; after that, it is sufficient to wear an insert with compresses on the wound surface. Rinsing and ointments should be avoided. Support for the healing process through analgesics and a recovery phase is advisable. The procedure has a recurrence rate of about 20% in men, but only about 4% in women, so the procedure is almost ideal for female patients. The recurrence rate is slightly higher in men, but due to the gentle initial operation, the “pit picking” method can be repeated without problems, even as often as desired, in case of a recurrence. Smoking and obesity increase the risk of recurrence. Overall, the fistulas heal completely after a “pit picking” operation after a maximum of 4 weeks, and the surgical area is completely dry.
