RU2328997C1 - Method of treatment of patients with perforated leg vein valve insufficiency complicated by trophic ulcers - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: endoscopic dissection of perforated veins is accompanied with perforation of bone area located in projection of trophic ulcer. Perforation is repeated 7-10 days after on the same area.

EFFECT: reduced time of treatment of perforated vein valve insufficiency.

4 dwg, 1 ex

Description

The invention relates to medicine, in particular to vascular surgery, and can be used in the treatment of patients with chronic venous insufficiency.

A known method of conservative treatment of patients with chronic venous insufficiency, including accompanied by the presence of trophic ulcers, involving the use of ointment dressings in combination with venotonic drugs and constant elastic compression of the affected limb (Vasyutkov V.Ya., Protsenko N.V. / Trophic foot ulcers and drumsticks. Library of the practical doctor. The most important issues of surgery // M .: Medicine, 1993. - P.65-113).

However, this method is associated with long periods of treatment and does not always allow to achieve complete healing of trophic ulcers.

There is a method of treating chronic venous insufficiency, accompanied by damage to the valves of perforating veins, by their endoscopic dissection (I.N. Grishin, V.N. Podgaysky, I.S. Starosvetsky "Varicose veins and varicose lower limbs", publishing house "Higher School ", Minsk, 2005, p.153-160).

However, in the presence of trophic ulcers, the use of the known method is also associated with long periods of treatment.

The objective of the invention is to develop a method that reduces the treatment time.

This problem is solved by the fact that in the method of treating patients with insufficiency of valves of perforating veins of the leg, complicated by trophic ulcers, including endoscopic dissection of perforating veins, simultaneously with the dissection of the veins, perforation of the bone site located in the projection of the trophic ulcer is repeated and it is repeated after 7-10 days on it same plot.

The method is illustrated by a description, an example of clinical use and illustrative material, which shows:

Figure 1. Type of limb of the patient before treatment; trophic ulcer in the lower third of the right lower leg.

Figure 2. Phlebogram of the right lower leg of the patient before treatment; arrows indicate perforating veins with abnormal venous blood flow.

Figure 3. Type of limb after the first operation.

Figure 4. Type of limb of the patient after treatment; ulcer epithelization.

The method is as follows.

After processing the surgical field under epidural anesthesia, an soft tissue incision is made in the upper third of the leg, into which the working part of the endoscope is subfascial in the direction from top to bottom. Moving it in the direction of the perforating veins previously detected by ultrasonic duplex scanning, they are closed by dissection by electrocoagulation or by applying plastic clips. After that, removing the endoscope, perforation of the tibia is performed on the site located in the projection of the trophic ulcer. For this purpose, from the side of healthy tissues, with the help of an electric drill, four to five times sequentially, multidirectionally, a Kirschner needle with a diameter of 1.5-2 mm is sequentially introduced and removed in the indicated area. Performing osteoperforation enhances arterial flow and microcirculation in the tissues, which in turn leads to increased tissue regeneration and stimulates ulcer healing. Moreover, the performed dissection of perforating veins and elimination of venous reflux through them allow avoiding the occurrence of venous hypertension due to an increase in arterial flow.

The operation is completed by suturing the wound with aseptic dressings.

In the postoperative period, to further stimulate the process of soft tissue regeneration and ulcer healing, after 7-10 days after the first operation, osteoperforation of the bone in the ulcer area is repeated. In the future, carry out planned dressings; if necessary, a course of therapeutic treatment is prescribed, including antibacterial therapy.

The practical use of the method is illustrated by the following clinical observation.

Patient I., 51 years old, East. disease number 38381, was admitted to the hospital with a diagnosis of Postthrombotic disease of the right lower limb. Chronic venous insufficiency III Art. Multiperforant insufficiency of the right lower leg. Trophic ulcer of the lower third of the right lower leg 3 × 4 cm (Fig.1, 2).

To eliminate venous reflux through perforating veins and healing trophic ulcers, the patient underwent surgery: Endoscopic dissection of perforating veins of the right lower leg, osteoperforation of the lower third of the right tibia.

During the operation, in the upper third of the right leg of the patient, a transverse section of soft tissues 4 cm in size was made, into which the working part of the endoscope was subfascial. Moving it in the distal direction, we performed a closed dissection of perforating veins by electrocoagulation. After that, perforation of the tibia was performed on the site located in the projection of the trophic ulcer. The needle was introduced from the side of healthy tissues in different directions, forming five perforations. The operation was completed by active drainage of the subfascial space with wound closure and the application of aseptic dressings (Figure 3). After 7 days, osteoperforation of the right tibia in the underlying ulcer area was repeated. After this, the trophic ulcer of the lower third of the right lower leg began to actively epithelize. By 11 days, its complete epithelization was noted with the formation of a dry scab, which completely disappeared by 17 days (Figure 4). The patient noted a decrease in swelling of the soft tissues of the lower third of the leg by 2.0 cm and in the middle third of the leg by 3.0 cm, a decrease in cyanosis of the skin of the lower third of the operated lower leg was observed, which indicated the elimination of venous reflux by perforating veins of the lower leg, normalization of the direction of venous blood flow of the operated limb and reducing the phenomenon of venous hypertension. The total treatment period was 24 days, which is on average 10-14 days less than the treatment time for patients with this pathology.

At the follow-up examination, after one year the treatment result is preserved: there are no signs of venous hypertension in the form of leg edema, as well as recurrence of trophic ulcer.

Using the method in the clinic RSC "WTO" them. Acad. G.A. Ilizarova showed that its use can reduce the treatment time for patients with valve insufficiency of perforating veins of the leg, complicated by trophic ulcers.

Claims (1)

A method for the treatment of patients with valve insufficiency of the perforating vein of the leg, complicated by trophic ulcers, including endoscopic dissection of the perforating veins, characterized in that simultaneously with the dissection of the veins, a portion of the bone located in the projection of the trophic ulcer is perforated and repeated after 7-10 days on the same site.

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