SU1186201A1 - Method of treatment of lymphostasis - Google Patents

Abstract

METHOD FOR TREATING LINFOSTAZA, vklyuchayupschy resection of abnormal regions of tissue and subsequent skin defect plate, characterized in that in order to prevent recurrence of edema, reduction of form and organ function, to plastic vsholn dissolved cellulocutaneous flaps comprising artery, vein, sensory nerves and lymph the collectors, transplanting it to the site of the defect, with the addition of microvascular anastomosis of the lymphatic vessels and veins of the flap. 2 1 00

Description

one

The invention relates to medicine, specifically to surgery, and is intended to treat severe forms of lymphostasis - elephantiasis.

The purpose of the invention is to prevent recurrence of edema, restore the shape and function of the organ.

The drawing shows a diagram of the operation according to the proposed method.

The method is carried out as follows.

The operation is usually performed by two teams of surgeons. One of them performs radical excision of pathologically changed tissues in the elephantiness zone and in the same place isolates artery 1 and vein 2 to apply the anastomosis to the feeding vessels of the flap. The second team performs locking 3, corresponding to the rachmaram defect, containing skin 4, subcutaneous tissue 5, supply leg vessels: artery 6, vein 7, and also lymphatic collector 8. After that, the flap is transferred to the defect site and placed under anesthetic magnification zirovanie arteries 1 and veins defect 2 area with the artery and vein 6 7 flap. This flap is fixed at the site of the defect with sutures and a microlimphenoan anastomosis of the lymphatic collector of the flap 8 is applied in one of its veins. The therapeutic effect is achieved due to plastics of the defect, after excision of pathologically changed tissues with healthy tissues containing skin, cellulose, lymphatic collectors and having autonomous blood circulation. Lymph from a transplanted flap is drained directly into the vein.

Example. Vol. T. Complaints about a pronounced increase in the volume of the external genital organs, frequent repeated erysipelas, lymph leakage from the scrotum and penis tissues, skin weeping of the genital organs, difficulty of erection, and the impossibility of performing the genital. act, significant inconvenience when committing the act of urination and walking. He considers himself sick for 8 years, when, after an injury to his left lower extremity, the foot and lower leg began to swell, then the edema spread to the hip and external genitals within two years. Since 1978, swelling

012

is stable. Over the period of the disease, he suffered more than 15 relapses of erysipelas. For the last three years, copious lymph leakage has been observed periodically from the skin of the penis, after which the patient has experienced short-term relief.

During the entire period of the disease, the patient received conservative treatment: diuretic, anti-inflammatory, desensitizing agents, massage, baths with potassium permanganate, furatsillinom, sage

and others, 2 years ago, marked fibrosis of the skin and fiber in the penis area was noted. Sexual dysfunction is 4 years. The patient was operated on.

microliphatic shunting at the level of the thigh with a satisfactory effect (persistent decrease in limb edema, absence of erysipelas) due to

lymphostasis of the left lower limb. On examination: a significant increase in volume, changing the shape of the penis and scrotum. Penis volume in the foreskin area

24 cm. The edges of the foreskin closed the external opening of the urethra, which made urination difficult. The scrotum is enlarged in volume (31 cm in the middle third), its lower edge reaches, the border of the lower and middle third of the thigh. The skin of the penis was not taken in the folds, not displaced, hilly, tight with warty growths.

and areas of maceration at the sites of lymph flow.

The patient decided to perform the operation according to the proposed method. Under peridural anesthesia, supplemented

neuroleptic algesia. Fibrous-altered tissues of the penis were excised and a plastic defect was made by microvascular transplantation of the back foot graft with micro-lymph lymph anastomosis of the lymphatic vessels and flap vein.

Technique of operation: from the longitudinal incision on the right in the area of the projection of the dorsal artery of the foot at the level of the ankle joint fissure are highlighted: superficial medial lymphatic collector, dorsal artery and marginal vein of the foot, as well as the internal cutaneous nerve of the foot foot. Vascular neural flap leg is recognized as suitable for transplantation. The fibrous-modified skin and cellulose of the penis, the resulting defect is 10 X 7 cm, are examined. After determining the size of the defect, the rear foot flap is taken according to the size of the supply vessels with the cutaneous nerve and the medial lymphatic collector of the flap. The flap was transferred to the site of the defect in the penis and fixed with separate stitches along the edge of the defect. Anastomosis of the flap artery and the left femoral artery was performed using an additional autovenous graft vein graft with a branch of the great saphenous vein of the left thigh. To improve the venous outflow into the dorsal vein of the flap, sewn and branches of the marginal vein. Then, the flap is finally fixed at the site of the defect and a microlohyphenous anastomosis is made by invaginating the lymphatic collector of the flap into one of the marginal veins, according to the type of end of the lymphatic vessel, into the vein block. Anastomoses are functioning satisfactorily. A fascicular microsurgical suture of a nerve flap from one of the anterior skin branches of the femoral nerve was performed. After that, the wounds are sutured in layers. The donor's place on the foot is covered with artificial leather followed by autodermoplasty (after 10 days). At follow-up examination polt nre engraftment of the flap. Edema of the penis and transplanted flap no. Scrotum slightly increased in. Lymphatic and erysipelas after the operation was not observed. Urination and walking does not cause inconvenience. Marks the restoration of sexual function. According to this method, operations were performed in two patients for lymphostasis of the external genital organs and in two patients for the post-mast syndrome. The rear foot flap was used in two cases, the medial hip flap in two patients. A good result was obtained in three cases, satisfactory in one pain.

Claims (1)

METHOD OF TREATMENT OF LYMPHOSTASIS, including resection of pathologically changed tissue sites and subsequent defect skin plate, characterized in that, in order to prevent recurrence of edema, restore the shape and function of the organ, plastic surgery is performed with a skin-fatty flap containing an artery, vein, sensitive nerves and lymphatic collectors , transplanting it to the place of the defect, while additionally performing microvascular anastomosis of the lymphatic vessels and veins of the flap. S b | s