SU1754074A1 - Method for surgically treating endarteritis obliterans - Google Patents

Abstract

Use: to increase efficacy and reduce traumatic indirect revascularization of the lower extremities. SUMMARY OF THE INVENTION: The skin-muscular pustolut on the microvascular leg of the latissimus wall is transplanted to the shin and foot, after removing the perimisium from the donor and recipient zone. The invention makes it possible to improve the results of treatment of patients with oblateritis endarteritis.

Description

The invention relates to medicine, namely to vascular surgery and microsurgery, and can be used in the treatment of chronic ischemia of the limb tissues, as a result of the occlusive-stenotic process of the leg and foot.

There is a method of treating chronic ischemia of the tissues by creating collateral circulation by moving the fixation on the surface of the organ with arterial insufficiency of a fragment of the greater omentum of the abdominal cavity.

The disadvantage of this method is that even with maximum lengthening of the omentum, it is impossible to locate it on the distal parts of the lower extremities most often subjected to chronic ischemia. This precludes the use of moving the greater omentum from the arsenal of means for the surgical treatment of occlusion of the leg and foot.

The closest to the present invention is a method of surgical treatment of obliterating endarteritis, including

revascularization of tissues by plastic autotissue on the vascular pedicle.

However, the known method is characterized by insufficient revsculation efficiency and high invasiveness of the operation.

The aim of the invention is to increase the efficiency of revascularization and reduce the morbidity of the operation.

The goal is achieved by the fact that, according to the surgical treatment of obliterating endarteritis of the lower extremities, including tissue revascularization by plastic autotissue on the leg, a muscle flap is used, while recurrences are removed from the entire contact area of the donor and recipient areas.

The method is carried out as follows.

As a rule, a flap is selected on the basis of the latissimus dorsi of the required width and length for placement on the entire surface of the tibia with the transition to the foot.

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ABOUT

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Removing the remix across the entire inner surface of the flap is produced after its mobilization, but before the intersection of the vascular pedicle. This technique provides the possibility of good hemostasis during excision of the remix and after using heparin during transplantation. Then, the flap is transferred to the shin and fixed to the shin muscles and foot tissues, where prelimications are also preliminarily removed over the entire contact area of the recipient zone. Then, an artery anastomosis of the Vi flap by an end to the side of the main vessel is performed under an operating microscope. The venous anastomosis is then performed and the flap is inserted into the bloodstream. The donor site is sutured.

Example. Patient I., 48 years old, was admitted with complaints of pain in the right lower extremity, aggravated at night and intermittent claudication of 50-70 m. The pain lasts for about 4 years. An examination of the angiogram revealed occlusion of the tibial arteries throughout, with the stump of the posterior tibial artery preserved and the network of small arteries at the medial ankle and on the foot. The popliteal artery is passable, segmetric pressure on the popliteal artery is 120 mm Hg. Art., on the tibial arteries x in the ankle joint, respectively, 20 and 10 mm Hg. Art. In the lower leg, the volumetric blood flow is reduced by 78%, the pulse blood flow on the foot of one finger is not detected. The polarography submitted showed that the oxygen tension on the tibia was 3–5 mm tr. Art. with a weakly positive sample for oxygen, while on the foot the POA was 0 without reaction to the inhalation of oxygen:

Operation: from the medial access on the tibia, a posterior tibial revision of the popliteal artery was performed. The arthritis is passable. Its wall is thickened. The posterior tibial artery is occluded in the region of the middle third of the armpit. Above is passable, however, after the intersection of its intima, it is denser, represented as a strain, the artery is recognized as non-anastomically capable. The popliteal arteries and the same name vein were selected as recipient vessels. The next step is the collection of the latissimus flap.

the spines of the ellipsoid configuration are 32 cm long, the maximum width of the skin part of the flap is 7 cm muscular 10–11 cm. Artery diameter is 3 mm, veins are 5 mm. contact of the donor zone with partial longitudinal dissection of muscle fibers and pre-fixation of the flap in the donor zone, where perimisium was also removed over the entire area of the recipient zone. The step of inserting the flap into the bloodstream was performed under an optical 8/0 filament increase by means of end-of-band anastomoses between the artery and vein of the flap and the popliteal vessels. Pain syndrome was stopped after 5 days after surgery. After 2 weeks, the patient began to walk independently. The trophic tendency tended to heal.

Examined after 6 months. The complete disappearance of pains of peace, healing of trophic ulcers, lack of feeling of freezing fingers were noted. The walking distance was increased to 200 - 300 m. There was a slight swelling of the leg up to 3 - 5 cm (compensated by wearing an elastic bandage), there was no swelling on the foot, the fingers were warm and the color was normal. After 12 months after surgery, the syndrome disappeared completely during slow walking with an increase in the walking distance of up to 1 km. Swelling of the leg and foot no.

According to this method, four patients were operated on. In all cases, the initial engraftment of the flap was achieved. Persistent mild ischemia was achieved on average by day 19.

The method is recommended for wide application in practice.

Claims (1)

Invention Formula A method of surgical treatment of lower extremity linging endarteritis, including tissue revascularization with plastic autograft on the vascular pedicle, characterized in that, in order to increase the effectiveness of revascularization and reduce the trauma of the operation, a muscle flap is used, while recipient zone removed perimisium.