Novosti
Khirurgii

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Year 2020 Vol. 28 No 4

CASE REPORTS

A.V. KOLSANOV, S.E. KATORKIN, P.N. MYSHENTSEV, P.M. ZELTER, A.V. KAPISHNIKOV, K.V. ZAGIDULLINA

THE ROLE OF COMPUTED TOMOGRAPHY IN PLANNING OPERATIVE TREATMENT OF A PATIENT WITH LYMPHEDEMA OF THE LOWER LIMBS

Samara State Medical University, Samara,
The Russian Federation

A 57-year-old patient was under observation; she had been suffering from the stage IV secondary lymphedema of the lower limbs for 16 years. During the examination, the clinical, laboratory studies, ultrasound scanning, computed tomography with 3D reconstruction and processing according to the “Autoplan” program were used. According to the preoperative examination, the patient underwent sequential partial dermalipofasciectomy operations.
This observation showed that the progressive course of the disease in the patient contributed to the development of a severe form of the secondary stage IV lymphedema with disfiguring deformity and significant dysfunction of the lower limbs. Computed tomography data showed that the density of soft tissues was increased almost throughout the thighs (-80, -93 HU). This indicated the complete replacement of adipose tissue with coarse connective tissue. Fibrous changes spread from the skin to the fascia and were circular. Due to the pronounced deforming edema, the volume of the right lower limb in the patient was 21576 cm3, and 23139 cm3 in the left one. During the operation, the computed tomography data processed using the “Autoplan” program provided a choice of tissue dissection method. In case of fragmented localization of fibrosis with density of -100 to -50 HU, tissue dissection was performed using a monopolar electrosurgical method. In case of widespread fibrosis with density below -50 HU, the optimal method of tissue dissection was mechanical, with consistent use of the monopolar coagulation mode. According to the results of computed tomography after the operation, not only thickness, but also density of the tissues significantly decreased with a tendency to an increase in the values of the Hounsfield index (-95, -105HU).
Qualitative and quantitative indicators obtained by computed tomography using 3D modeling and the «Autoplan» program make it possible to establish indications for surgical treatment, to determine the optimal resection volume, as well as parameters for dissection of pathologically affected tissue, and to ensure control in the postoperative period.

Keywords: lymphedema of the lower limbs, lymphatic edema, surgical treatment, computed tomography, 3D modeling
p. 449-455 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 Evgenyevich
Information about the authors:
Kolsanov Alexandr V., MD, Professor of RAS, Rector, Head of the Department of Operative Surgery and Clinical Anatomy with the Course of Innovative Technologies, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0002-4144-7090
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
Myshentsev Pavel N., PhD, Associate Professor of the Hospital Surgery Deparment, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0001-7564-8168
Zelter Pavel M., PhD, Assistant of the Department of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0003-1346-5942
Kapishnikov Alexandr V., MD, Head of the Department of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0002-6858-372X
Zagidullina Ksenia V., Clinical Resident, the Deparment of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0003-4576-3709
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