RU2284155C1 - Method for subfascial dissection of perforating veins of shin at chronic venous failure - Google Patents

Abstract

FIELD: medicine, vascular surgery.

SUBSTANCE: the present innovation deals with subfascial dissection of perforating veins of shin in case of chronic venous failure of inferior limbs. For this purpose, it is necessary to carry out a thorough isolation of perforating vein at the whole length of subfascial space, then one should isolate stems into which it is divided at the site of its incoming into a deep vein, then they should be separately sutured and bound at the distance of 1 mm against the wall of a deep vein. Then perforating vein should be sutured and bound at a deep fascia, one should carry out dissection of perforating vein and then the dissected part should be removed out of the wound. The innovation enables to considerably decrease horizontal veno-venous drop at a shin, and, also, remove anatomical substrate more thoroughly to avoid the development of complications and relapses in postoperational period.

EFFECT: higher efficiency.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to vascular surgery, specifically to methods of subfascial dissection of perforating veins of the leg in chronic venous insufficiency of the lower extremities.

There is a method of subfascial endoscopic dissection of perforating leg veins, which consists in the fact that in the subfascial space of the leg using a video endoscope they are coagulated or clipped (Ministry of Health of the Russian Federation, Methodical recommendations 97/134 “Endoscopic dissection of perforating veins in varicose veins”, page 4 -9).

However, the above method of processing insufficient perforating veins of the leg during operations for chronic venous insufficiency has a significant drawback, namely, that coagulation and clipping of the perforating complex is performed far from the superficial vein and deep vessels. Separation of the superficial and deep venous systems without taking into account the anatomical structure of the perforating complex leads to the abandonment of necrotic tissues and long stumps of the turned off vessel. This threatens the development of inflammatory and thrombotic processes. The objective of the invention is to reduce the number of postoperative complications and relapses of the disease. This object is achieved in that according to the method of subfascial dissection of perforating veins of the leg in chronic venous insufficiency of the lower extremities, including the isolation, ligation and intersection of insolvent perforating veins, thoroughly isolate the perforating vein throughout the subfascial space, allocate trunks into which it is divided in place into a deep vein, then they are separately stitched and bandaged at a distance of 1 mm from the wall of a deep vein, followed by a perforated vein they are stitched and bandaged at the deep fascia, a perforating vein is excised, and subsequently, the excised area is removed from the wound.

The method is as follows.

On the back surface of the lower leg (outside the zone of trophic disorders) in the middle and lower third, an incision is made of the skin, subcutaneous tissue and deep fascia 5-10 cm long. Throughout both the medial and lateral surfaces, the fascia of the leg is separated from the muscles. After that, perforating vein is determined under direct visual control, it is isolated throughout the subfascial space. The trunks into which it is divided at the place of flowing into the deep vein are separately stitched and bandaged at a distance of 1 mm from the wall of the deep vein with a non-absorbable atraumatic thread 5-0. Then the perforating vein is stitched and bandaged at the fascia of the lower leg. Using vascular scissors, a perforating vein is dissected inward from the ligatures, and its excised section is removed from the wound.

The creation of this method was facilitated by data from 73 operations on perforating veins of the lower leg, during which they were carefully selected throughout the subfascial space. It turned out that in all cases the perforant is divided into several trunks before it enters the deep vein (photo 1, number one indicates the trunks of the perforated vein into which it is divided before it enters the deep vein). We stitched them and bandaged them at a distance of 1 mm from the wall of a deep vein, as this avoids its deformation. Stitching and dressing of the perforant directly at the fascia of the lower leg and at the deep vein allowed us to reduce the length of the stump of the vessel and minimize the possibility of slipping ligatures and the development of bleeding in the postoperative period. In addition, in the future, this reduces the risk of varicose transformation and thrombosis of perforating vessel stumps. This is the prevention of relapse of the disease and the occurrence of a source of thromboembolism and pulmonary artery. The excised section of the perforating vein was excised to reduce the volume of necrotic and inflammatory tissue changes.

Example. Patient S., 46 years old. Diagnosis: Postthrombotic disease of the right lower limb, ulcerative form, art. decompensation, chronic venous insufficiency of the lower extremities of 6 cells, the diagnosis is confirmed by ascending distal venography, ultrasound. Deep veins are recanalized, passable. The operation according to the proposed method. A 7 cm long incision was made along the posterior surface of the lower leg in the middle and lower third. The fascia of the lower leg from the muscles was separated from the medial and lateral surface. 7 insufficient perforating veins from 4 to 8 mm in diameter were visualized, with the help of a dissector, they were selected throughout the subfascial space, including the division site at the deep vein, they were stitched and bandaged at the deep fascia and 1 mm from the deep vein with non-absorbable atraumatic thread 5 -0. Using vascular scissors, perforating veins were dissected inwards from the ligatures, and their excised sections were removed from the wound. In the postoperative period he received antibiotics, antiplatelet agents, dressings. The wound healed by primary intention. Ulcer epithelization occurred on the 4th day. Pain and limb edema were stopped. Control phlebographic and ultrasound examination before discharge showed the absence of low venous-venous discharge. On day 14, the patient was discharged home in satisfactory condition. Long-term results are evaluated after 2 years. There was no relapse of the trophic ulcer. Trophic skin changes are absent.

We operated on 73 patients suffering from CVI in the stage of decompensation with trophic ulcers (their size varied from 0.5 to 6 cm, duration of existence from 3 months to 5 years), there were no postoperative complications, and relapses of the disease.

Thus, the new knowledge obtained in the course of clinical studies has allowed us to propose a new approach to surgical technique during the performance of subfascial dissection of perforated veins of the lower leg. The proposed method is anatomically and functionally justified, as it allows to significantly reduce the horizontal venous-venous discharge on the legs, as well as the most complete removal of the anatomical substrate to prevent the development of complications and relapses in the postoperative period.

Claims (1)

The method of subfascial dissection of perforating veins of the lower leg with chronic venous insufficiency of the lower extremities, including the isolation, ligation and intersection of insolvent perforating veins, characterized in that they thoroughly isolate the perforating vein throughout the subfascial space, allocate trunks into which it divides at the site of deep penetration vein, then they are separately stitched and bandaged at a distance of 1 mm from the wall of the deep vein, after which the perforated vein is stitched and bandaged at the deep side fascia, perforating vein is excised and subsequently excised section is removed from the wound.