Year 2021 Vol. 29 No 1

REVIEWS

S.E. KATORKIN 1, S.A. SUSHKOU 2, M.Y. KUSHNARCHUK 1

CURRENT STANDARDS OF SURGICAL TREATMENT FOR VENOUS TROPHIC ULCERS OF THE LOWER EXTREMITIES

Samara State Medical University 1, Samara,
The Russian Federation
Vitebsk State Medical University 2, Vitebsk,
The Republic of Belarus

Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standards are proposed. The main aim of surgical therapy is the elimination of the lower extremity venous reflux so that the solution of this problem significantly reduces the incidence rate of recurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation (MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplasty with free split perforated cutaneous flap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery (SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous reflux in the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation.

Keywords: chronic venous diseases, venous trophic ulcers of the lower limbs, chronic venous compartment syndrome, vein surgery, endovenous therapy, shave therapy, endoscopic dissection of perforating veins, fasciotomy
p. 75-89 of the original issue
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Address for correspondence:
443013, Russian Federation,
Samara, Karl Marks pr., 165b,
Samara State Medical University,
the Department and Clinic of Hospital Surgery
Tel. +7 927 206-71-02,
e-mail:katorkinse@mail.ru
Katorkin Sergei E.
Information about the authors:
Katorkin Sergei E., MD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Sushkou Siarhei A., PhD, Associate Professor, Vice-Rector of Scientific and Research Affairs, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-7524-6182
Kushnarchuk Mikhail Y., Cardiovascular Surgeon, the Department of Vascular Surgery of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation. https://orcid.org/0000-0001-8764-2054
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