Eighty eight incompetent perforating vein (IPV) ligations were performed in 64 patients who were followed up for a minimum of two years, mean 4.4 years. The long term results were good in 85% of cases. It is suggested that IPV ligation is the optimum treatment for venous ulceration and lipodermatosclerosis in patients who have only calf vein damage and that in most cases preoperative ascending venography is not necessary.