Novosti
Khirurgii

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Year 2014 Vol. 22 No 6

GENERAL AND SPECIAL SURGERY

S.E. KATORKIN, A.A. ZHUKOV, M.J. KUSHNARCHUK

COMBINED TREATMENT OF VASOTROPHIC ULCERS IN LOWER LIMBS CHRONIC VENOUS INSUFFICIENCY

SBEE HPE “Samara State Medical University”,
The Russian Federation

Objectives. To optimize approaches to treatment of the C6 class patients by combined application of surgical correction methods, autodermoplasty and combined impact of a low-intensity laser radiation and fine dispersion drug irrigation of the trophic ulcers.
Methods. The examination and treatment of 160 patients of C6 class were carried out. In 102 (63,7%) patients in the group I a combined impact of laser radiation and fine dispersion drug irrigation were applied. In the II group (n=58) patients were treated with standard methods.
Seventy (68,6%) patients of the 1st and thirty-four (58,6%) of the 2nd group were operated on. Phlebectomy was conducted together with the operations of Cokkett – 25 (24,5%), Linton – 20 (19,6%), SEPS – 32 (31,4%), SEPS and fasciotomy – 17 (16,7%), autodermoplasty – 94 (58,7%). Assessment of long-term results of combined treatment has been carried out (3 months – 3 years).
Results. In the 1st group on the 5th day a decrease of microbial contamination levels from 107–108 to 104–105 (ð<0,05) was registered, and on the 20th day – its absence was established. Dynamic parameters of epithelialization prevailed in the 1st group more than in 2-folds (p<0,05). Clearing of the surface, appearance of granulation and epithelialization beginning made up 4,2±1,1 and 9,6±1,3, 5,9±0,8 and 13,1±2,1, 8,9±1,2 and 23,3±1,6 days, respectively. The complete epithelialization in patients of the 1st and 2nd groups was 29,1±0,7 and 46,2±0,8 days (p<0,05). 12 months after the conservative treatment, trophic ulcer recurrence in the 1st group made 34,8%, and in the 2nd group – in 66,7%. Preoperative preparation in the 1st group reduced the preoperative period by 2,8 folds. Full engraftment of the autodermotransplant in the 1st group was achieved in 75% of cases, in the 2nd – in 32,3%.
Conclusion. The method of local application of the combined low intensity laser radiation and fine dispersion drug irrigation is on is desired to be a pathogenetically substantiated non-invasive method of conservative treatment and preoperative preparation of the trophic ulcers in the C6 class patients.

Keywords: venous trophic ulcer, chronic venous insufficiency, surgical treatment, autodermoplasty
p. 701-709 of the original issue
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Address for correspondence:
443079, Rossiyskaya Federatsiya,
g. Samara, pr. Karla Marksa, d. 165 «b»,
Kliniki Samarskogo gosudarstvennogo
meditsinskogo universiteta,
kafedra i klinika gospitalnoy khirurgii.
tel. office 8 107 846 276-77-89,
e-mail: katorkinse@mail.ru,
Katorkin Sergey Evgenevich
Information about the authors:
Katorkin S.E. PhD, an associate professor of the chair and clinic of hospital surgery of SBEE HPE “Samara State Medical University”.
Zhukov A.A. A day-time postgraduate student of the chair and clinic of hospital surgery of SBEE HPE “Samara State Medical University”.
Kushnarchuk M.J. A clinical resident of the chair and clinic of hospital surgery of SBEE HPE “Samara State Medical University”.
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