RU2423926C1 - Method of surgical treatment of lymphedema of lower extremities - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine, namely to surgery. Through skin puncture ligature is passed through entire layer of cellular tissue to fascia and through stick out ligature is passed out. After that through the same stick out immediately under skin ligature is passed to the first puncture. By means of formed loop of cellular tissue gripping it is cut and in the same manner circular subcutaneous cutting of subcutaneous adipose cellular tissue is performed at each level from foot to knee joint. Compressive bandages are applied in zone of cellular tissue cutting. ^ EFFECT: method makes it possible to exclude trauma of skin, as well as to increase treatment efficiency due to formation of lymph-venous and lymph-muscular discharge of lymph without traumatic dissection of cellular tissue space, which provides cosmetic effect. ^ 3 dwg, 1 ex

Description

The invention relates to medicine and can be used in the treatment of primary and secondary lymphedema of the lower extremities of the I-III stage.

A known method for the treatment of elephantiasis, including radical total removal of fibrous altered fascia and subtotal removal of fibrous subcutaneous tissue by economical linear dermatolipofasciectomy (RF patent No. 2026011, IPC АВВ 17/00, publ. 1995).

The disadvantages of this method are its high morbidity, the impossibility of its use in a number of patients (by age, somatic diseases), the inability to affect the entire cellular tissue of the lower leg, the formation of rough scars in the postoperative period. The application of extensive wounds leads to a high percentage of postoperative suppuration and necrosis in the area of the edges of the wounds, neurological disorders are possible.

A known method for the surgical treatment of lymphedema, including mechanical tube lipoextraction and myectomy along the external, internal and anterior limb contours (RF patent No. 2192170, IPC АВВ 17/00, publ. 2002).

This method does not allow to radically remove all affected cellular space. Closed cavities created by tube scalpels are subject to suppuration and filling with lymphatic fluid. In stage III of the disease, damage to the skin and muscles is possible due to the difficulty of holding tube scalpels in scarring or already changed fatty tissue. High risk of arterial bleeding.

A known method of surgical treatment of lymphedema, including the application of circular subcutaneous pressure sutures around the circumference of the lower leg at several levels (RF patent No. 2317783 IPC АВВ 17/00, publ. 2006, prototype).

The disadvantages of this method are the need for ligation of the large saphenous vein (BPV) to exclude thromboembolism, the patient’s long stay in the hospital due to the need for constant ligature tension while reducing leg swelling, the need to remove subcutaneous ligature, complete scarring of the cellular space in the circular suture is not always achieved, what this method is aimed at.

The task of the invention is to remedy these shortcomings, increase the effectiveness of treatment while reducing trauma by eliminating damage to the skin, the formation of lymphovenous and lympho-muscular lymph discharge without radical excision of the cellular space.

To this end, in the method of surgical treatment of lymphedema, including the action of a ligature on the subcutaneous fat along the circumference of the lower leg sequentially from the foot to the knee joint at a distance of 4-6 cm from each other, it is proposed to ligature through the entire thickness of the tissue to the fascia and through the puncture through a skin puncture bring the ligature out, then through the same puncture directly under the skin, conduct the ligature to the first puncture formed by the fiber capture loop to dissect it, then in the same way carry out a circular subcutaneous zhnoe dissection of the subcutaneous fat at every level from the foot to the knee, then apply a pressure bandage to the area cut fiber.

In this way, lymph drainage along the altered fatty tissue along the entire circumference of the tibia is excluded, and complete scarring of the cellular space in the area of its dissection is achieved.

The method eliminates thromboembolism without ligation of BPV, shortens the patient's hospital stay, provides a high cosmetic effect, excludes neurological disorders.

Figure 1 presents a diagram of the formation of an exciting subcutaneous loop for dissection of subcutaneous fat on the lower leg;

figure 2 - the destruction of the captured area of subcutaneous fat;

figure 3 - complete circular destruction of subcutaneous fat at the same level.

The drawing shows: 1 - skin, 2 - subcutaneous fat, 3 - muscles and fascia, 4 - bones, 5 - needle puncture, 6 - needle puncture, 7 - hypodermicly formed capturing loop of polyvinyl chloride line, 8 - destroyed subcutaneous fatty tissue on one level, 9 - skin punctures.

The implementation of the method shown in specific clinical examples.

Example 1

Patient N., 48 years old, was admitted to the department of vascular surgery with complaints of pain, severity and persistent swelling of the left leg. Lymphedema III Art. Sick 15 years, the disease connects with heredity.

The patient's condition is satisfactory. Sick of increased nutrition. For internal organs without features A \ D 130/80 mm Hg Pulse 72 per minute. The left lower leg compared to the right is increased in a circle of + 12-15 cm, the skin is sharply thickened, its induction, pigmentation, and hyperkeratosis are noted. There is a dense inductive edema of the left lower leg. With UZDG, pathologies of the venous system of the lower extremities were not detected.

The operation is performed under epidural anesthesia, after processing the surgical field, a circular subcutaneous dissection of the subcutaneous fat is performed at 5 levels from the foot to the knee joint.

Using a needle with a removable handle, at the same level, through a puncture of the skin, the needle, followed by a ligature (polyvinyl chloride line No. 9), captures the entire thickness of the fiber to the fascia and pokes out through the puncture, then passes through the same puncture directly under the skin ligature to the first puncture, a loop of fiber capture is formed, with the help of which it is dissected. A similar dissection of the cellular space is made circularly at all levels.

Fascias, muscles during this operation are not injured. The distance between the circular subcutaneous dissection of fiber is 5-6 cm. The surgical field is treated with iodine, pressure bandages are applied in the section of fiber dissection, and elastic limb bandage is performed. Daily change of aseptic dressings and elastic bandaging of the limb.

The patient was discharged on the 7th day after the operation. At the time of discharge, the circumferences of the legs are equal.

Examination after a year: the tibia around the circumference has the correct shape, there are no scars, the left tibia is +1 cm, there are no complaints of pain, a feeling of heaviness and swelling.

Example 2

Patient S., 45 years old, was admitted to the department with complaints of dense, non-resolving swelling of the legs. Sick for about 10 years, the disease is associated with heredity and repeated erysipelas of the legs. Lymphedema 2 tbsp.

The patient's condition is satisfactory. Obesity 2 tbsp., Internal organs without features. A \ D 140/85 mm Hg Pulse 64 per minute. The tibia is enlarged in circumference, the left one is +17 cm, the right one is +13 cm. The skin of the tibia is thickened, there are no trophic skin disorders, there is no pastosity with finger pressure. With UZDG, pathologies of the venous system of the lower extremities were not detected.

According to the proposed method, the operation on the left lower leg was performed. Circular subcutaneous dissection of subcutaneous fat at 7 levels from the foot to the knee. The distance between the circular subcutaneous dissection of fiber is 5-6 cm. The surgical field is treated with iodine, pressure bandages are applied in the section of fiber dissection, and elastic limb bandage is performed. Daily change of aseptic dressings and elastic bandaging of the limb. The patient was discharged on the 7th day after the operation. At the time of discharge, the left lower leg is 10 cm compared to the right.

Disability recovery after 21 days.

Examination after a year: the left lower leg compared to the right - 10 cm, the lower leg has the correct shape, there are no scars, the patient insists on surgery on the right lower limb.

The developed technique was applied in the treatment of lymphedema of I-III art, in 10 patients.

The immediate and long-term complications were not noted. The operation time is 20-30 minutes.

Patients are monitored from 1 to 4 years.

The operation is less traumatic, performed in one step, gives a good therapeutic and cosmetic effect, does not require a long stay of the patient in the hospital, in the postoperative period, patients did not notice severe pain and discomfort. Disability in the postoperative period is 21 days.

With this operation, the skin is not injured, circular dissection of fiber at several levels allows to achieve dissection of the altered lymphatic vessels and complete scarring of the fiber in this area, which will stop lymph drainage along it.

Claims (1)

A method for surgical treatment of lower limb lymphedema,
including the implementation of the impact of the ligature on the subcutaneous fat along the circumference of the lower leg sequentially from the foot to the knee joint at a distance of 4-6 cm from each other, characterized in that a ligature is passed through the skin through the entire thickness of the fiber to the fascia and the ligature is brought out through the puncture, then, through the same puncture, directly under the skin, a ligature is carried out to the first puncture, a fiber is cut through the capture loop, then it is cut, then in the same way circular subcutaneous dissection of subcutaneous fat is performed second fiber at every level from the foot to the knee joint, a pressure bandage applied in the area of cut fiber.

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