Dermatoplasty for decompensated forms of varicose veins and post-thrombotic syndrome

Abstract

Objective(s). In order to improve the results of the treatment of the decompensated form of varicose veins and post-thrombotic syndrome, taking into account the angiosomal theory and using VAC and Magott therapy of the recipient woundof the trophic ulcer, evaluate different methods of dermatoplasty depending on the depth and area of the lesion. Methods. In the surgical clinic of the regional hospital named after A. Novak, 174 patients with chronic venous insufficiency (CVI) in the stage of lecompensation were under our observation. According to the etiology of the disease, there were 76 patients with varicose desease (VD) (group I), 98 patients with PTS (group II), while 27 patients with PTS had trophic ulcers on both lower extremities. With a trophic ulcer (TU) diameter of up to 10 cm in the I group of patients, 42.1% had the depth of the lesion of the IIst, and in the patients of the IIa group, the depth of the lesion was the IIIrd. was observed in 51.4% of cases. In the 1st group (76) patients, TU was cleaned with the help of VAC therapy in 32 patients, Magott therapy was used in 18 patients. TcpO2 was measured in the angiosomes of the anterior tibial artery (APA), posterior tibial artery (PTA), and peroneal artery (PA), as the corresponding arteries participate in the perfusion of the corresponding skin-muscle flaps Results. Rejection (lysis) of the graft was observed in 5 (6.6%) patients of the 1st group, and only in patients with dermatoplasty using the vintage method. Graft lysis was observed in 4 (5.6%) patients of the IIa group, in two with the vintage method and in two with split graft transplantation. In the IIb group (both limbs affected), partial lysis of the transplanted perforated split graft was observed in three limbs (6%). No complications were observed when the tissue complex was transplanted freely. Conclusions. Free flaps are units of tissue that can be transplanted from the donor site to the recipient wound while maintaining its blood supply. Pieces can be classified by the type of blood supply, their tissue composition, the method of transplantation, or the orientation of the vessels. The concept of angiosomes and venosomes explains the blood supply to the recipient wound necessary for the viability of the flap. Various monitoring methods are used to monitor patients after surgery, including assessment of physiological parameters and auxiliary methods (dopplerography, transcutaneous and epidermal oximetry). Factors affecting the viability of transplants after surgery include: thorough surgical intervention, adequate immobilization after surgery, prevention of infection, and adequate vascularization of the recipient wound.

Keywords

• microcirculation
• trophic ulcer
• varicose disease
• postthrombophlebotic syndrome
• angiosome
• regional perfusion index