RU2360621C1 - Way of elimination of perforans dump at varicose illness of lower limbs - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely surgery. The cut of a skin, hypodermic fat and a deep fascia in length about 3 cm on a medial or back surface of an anticnemion in its average third out of a zone of trophic disorders is carried out. The fascias are separated from the muscles on a small extent. The operational radiographic cone with optical system which is connected through a videocamera to the monitor is entered into a wound in a subfascial manner. The fascias are exfoliated in a blunt manner from the muscles under a direct vision, insufficient perforans veins are allocated by means of a dissector entered through the working channel of an endoscope, coagulated and crossed found out. The high dressing and crossing of trunks of hypodermic veins and their excision is carried out using Babcock's method, and the varicose-expanded inflows of the big and small hypodermic veins from separate small cuts - using Narat's method. The wounds are taken in. Thus the fabric implant from titan titan, made of a thread in diametre 50-60 microns with the size of cells less than 250 microns is established under the fascia.

EFFECT: way dilates an arsenal of agents for elimination of a perforans dump at varicose disease of the lower limbs.

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Description

The invention relates to medicine, namely to surgery, and is intended for the treatment of patients with varicose veins of the lower extremities and trophic disorders of the soft tissues of the lower leg.

Known methods of surgical treatment to eliminate perforating venous discharge outside the area of trophic disorders, for example, "blind" subfascial intersection of the communicative veins of the lower leg [1], obstruction of the posterior tibial veins throughout [2].

A disadvantage of the known methods is that a closed intersection cannot be sufficiently radical and is accompanied by the formation of a significant subfascial hematoma, and in the case of obstruction of the posterior tibial veins there is a medial and posterior venous discharge to the lower legs, complicated by severe thromboembolic complications.

The closest technical solution is the method of Linton endoscopic surgery to eliminate perforating discharge in case of varicose veins of the lower extremities in order to accelerate the healing of trophic ulcers and eliminate trophic disorders of the soft tissues of the lower leg, in which on the medial or posterior surface of the lower leg in its middle third (outside the zone of trophic disorders) they perform an incision of the skin, subcutaneous tissue and deep fascia about 3 cm long, for a short distance, the fascia is separated from the muscles and subfascial injected The oval operating tube with an optical system connected through a video camera to the monitor, under visual inspection, the fascia is bluntly exfoliated from the muscles, insufficient perforating veins are detected by a dissector inserted through the working channel of the endoscope, coagulated and intersected, high ligation and intersection of saphenous vein trunks are performed , their removal according to Beccoccus, removal of varicose-dilated inflows of the large and small saphenous veins from separate small sections along Narat, the wounds are sutured [3].

The disadvantage of this method is the possibility of recurrence of trophic disorders and leg ulcers due to newly formed functionally deficient perforating veins.

The objective of the invention is to increase the effectiveness of surgical treatment of patients with varicose veins of the lower extremities, trophic disorders of soft tissues and leg ulcers by preventing the formation of functionally deficient perforating veins in the area of trophic disorders.

The technical result of the invention is that as a result of the use of a thin-section tissue implant made of titanium nickelide, made from a thread with a diameter of 50-60 μm with a mesh size of less than 250 μm, placed subfacially in the area of trophic disorders of the soft tissues of the leg in patients with varicose disease of the lower extremities, the effect of separation of the superficial and deep venous systems of the lower leg is achieved, excluding the formation of both direct and indirect communicative veins in the affected area. This circumstance contributes to the improvement of trophism of affected tissues with the subsequent elimination of pigmentation and healing of ulcers. Due to the biochemical and biomechanical compatibility of titanium nickelide with biological tissues, implants from this material function for a long time in the body without tearing away, and the connective tissue grows through the cellular structure of the implant, thus forming a connective tissue regenerate that is unified with the implant material.

The specified technical result is achieved by the fact that in the method of surgical treatment of varicose veins of the lower extremities and trophic ulcers of the lower leg, including an incision of the skin, subcutaneous tissue and deep fascia about 3 cm long on the medial or posterior surface of the lower leg in its middle third (outside the area of trophic disorders), separating the fascia from the muscles for a short distance, subfascial introduction of a special surgical tube with an optical system connected through a video camera to the monitor, peeling off in a blunt way from muscles under visual fascia control, isolation using a dissector introduced through the working channel of the endoscope, coagulation and intersection of detected insufficient perforating veins, high ligation and intersection of saphenous vein trunks, their removal according to Beccoccus, removal of varicose dilated inflows of the large and small saphenous veins from individual small sections according to Narat, suturing wounds, new is that under the fascia a tissue implant of titanium nickelide is made, made of a thread with a diameter of 50-60 microns with a mesh size of less 250 microns.

A thin-section tissue implant made of titanium nickelide, made of a thread with a diameter of 50-60 microns with a mesh size of less than 250 microns, placed subfascial, prevents the formation of insufficient perforating veins through its structure.

The method is as follows. An incision is made in the skin, subcutaneous tissue and deep fascia about 3 cm long on the medial or posterior surface of the lower leg in its middle third (outside the area of trophic disorders), the fascia is separated from the muscles for a short distance, a special surgical tube with an optical system is connected subfascial to the wound, connected through the video camera to the monitor, the fascia is peeled off bluntly from the muscles under visual control, isolated with the help of a dissector inserted through the working channel of the endoscope, the detected defects are coagulated and crossed fine perforating veins, subfascial, in the projection of tissue trophic disorders, a thin-section tissue implant made of titanium nickelide made from a thread with a diameter of 50-60 microns with a mesh size of less than 250 microns throughout the affected area is placed, they perform high ligation and intersection of the saphenous vein trunks, and remove them according to Beccoccus, removal of varicose dilated tributaries of the large and small saphenous veins from separate small sections along Narat, suturing wounds.

Example. Patient M., 68 years old, went to the clinic for varicose veins of the right lower limb, trophic ulcer of the anterior part of the lower third of the leg. Really: under the skin of the inner surface of the right thigh and the upper third of the lower leg, varicose veins are determined by the main and saccular type, in the lower third of the inner surface of the lower leg there is a pronounced pigmentation of tissues, in the center of which destructive changes of an oval shape, 3.0- 4.0 cm, with rough edges and dirty gray granulations. Duplex scanning determined the failure of the valvular apparatus of the superficial venous system, the presence of a communicative vein under the ulcer, with failed valves and the discharge of venous blood from the deep into the superficial venous system, and the deep venous system without visible pathology. Diagnosis: varicose disease of the right lower limb, trophic ulcer of the lower third of the right lower leg. The operation was performed: an incision was made in the skin, subcutaneous tissue and deep fascia 3 cm long on the medial surface of the lower leg in its middle third outside the area of trophic disorders, the fascia from the muscles was separated for a short distance, a special surgical tube with an optical system connected via a video camera was subfascial in the wound to the monitor, under visual control, the fascia is bluntly detached from the muscles, using a dissector inserted through the working channel of the endoscope, functionally undershot are selected, coagulated and crossed fine perforating veins, subfascial, in the projection of tissue trophic disorders, a thin-section tissue implant made of titanium nickelide made of a thread with a diameter of 60 μm with a mesh size of less than 250 μm over the affected area was placed, high ligation and intersection of the saphenous vein trunks, their removal according to Beccock removal of varicose dilated tributaries of the large and small saphenous veins according to Narat, the wounds are sutured. The postoperative course is smooth, the sutures were removed after 10 days. Wound healing is primary. On examination after 6 months, good anatomical and functional results were noted.

Clinical trials of the proposed method were carried out on 12 patients with varicose veins of the lower extremities, trophic disorders of soft tissues and leg ulcers who underwent venectomy of the superficial veins of the lower extremities with the intersection of functionally deficient communicative veins in the area of trophic tissue disorders using the proposed implants. As a result of monitoring patients for 3 years, no anatomical and functional disorders of the lower leg were revealed.

Information sources

1. Edwards J. M. // Brit. J. Surg. - 1976. - Vol. 63. - P. 885-890.

2. Vedensky A.N., Stoyko Yu.M., Mankevich V.A., Shaydakov E.V. // All-Russian scientific-practical. Conf. 75th anniversary of prof. R.P. Askerkhanova: Abstracts. - Makhachkala, 1985 .-- S.10-12.

3. Saveliev B.C. Linton endoscopic surgery / V.S. Saveliev, A.I. Kiriyenko // Thoracic and cardiovascular surgery. - 1997, No. 3. - S.24-26.

Claims (1)

A method for eliminating perforating discharge in case of varicose veins of the lower extremities, including an incision of the skin, subcutaneous tissue and deep fascia about 3 cm long on the medial or posterior surface of the lower leg in its middle third outside the zone of trophic disorders, separation of the fascia from the muscles for a short period, subfascial introduction to the wound an operating tube with an optical system connected through a video camera to the monitor, exfoliating in a blunt way from the muscles under the visual control of the fascia, isolating with the help of a dissector, we introduce through the working channel of the endoscope, coagulation and intersection of the detected insufficient perforating veins, high ligation and intersection of the saphenous vein trunks, their removal according to Beccock, removal of varicose dilated inflows of the large and small saphenous veins from individual small sections along the Narat, suturing wounds, characterized in that under the fascia a tissue implant of titanium nickelide is made, made of a thread with a diameter of 50-60 microns with a mesh size of less than 250 microns.