Biological necrectomy and vacuum-therapy in complex treatment of decompensated chronic venous insufficiency of the lower extremities

Abstract

Objective. To improve the results of treatment in patients, suffering decompensated forms of chronic venous insufficiency (CHVI) of the lower extremities, using introduction of biological necrectomy and vacuum-therapy in combination with complex of optimal surgical interventions, depending on state of venous hemodynamics of the lower extremities. Materials and methods. In 2015-2018 yrs in Surgical Clinic of the Zakarpattya Regional Clinical Hospital named after Andriy Novak 147 patients, ageing 40 yrs old and older, suffering CHVI Category C6 in accordance to the CEAP Classification, were treated. All the patients were divided into two groups: the Group I consisted of 76 patients, suffering CHVI in decompensated stage on background of varicose disease, and the Group II - 71 patients, suffering trophic ulcers (TU) on background of postthrombophlebitic syndrome (PTHPHS). Results. There was established, that the TU clearance under the action of maggot-therapy in patients, suffering decompensated course of CHVI, is significantly more effective, than under the impact of vacuum-therapy. Autodermoplasty must be performed in all the patients, having TU with 4 cm in diameter, Good and satisfactory results were observed in 75 (98.7%) patients of Group I and in 63 (88.7%) patients of Group II, while poor results - in 8 (11.3%) patients of Group II. The working capacity of patients, suffering CHVI in decompensated stage of varicose genesis, have enhanced in 16.5 times, while in the patients, suffering TU on background of PTHPHS – in 1.25 times. Conclusion. Combined treatment of CHVI in decompensated stage, occurring on background of varicose disease includes the TU clearance, using vacuum-therapy or biological necrectomy with subsequent elimination of vertical reflux. In the patients, suffering TU on the PTHPHS background the biologic necrectomy with elimination of horizontal reflux is advantageous. The working capacity in patients with CHVI in decompensated stage of varicose genesis have enhanced in 16.5 times, while in the patients with TU on the PTHPHS background - in 1.25 times.

Keywords

• chronic venous insufficiency in decompensation stage; varicose disease; postthrombophlebitic syndrome; venous hypertension; vertical and horizontal refluxes; maggot-therapy; vacuum-therapy; crossectomy; short stripping; distal scleroobliteration; echoscleroobliteration; autodermoplasty.