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Khirurgii

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Year 2015 Vol. 23 No 2

GENERAL AND SPECIAL SURGERY

S.E. KATORKIN, M.V. NASYROV

LOCAL TREATMENT AND PREOPERATIVE PREPARATION OF VENOUS TROPHIC ULCERS USING PHOTODYNAMIC THERAPY

SBEE HPE "Samara State Medical University"
The Russian Federation

Objectives. To optimize local treatment and preoperative preparation of trophic ulcers (TU) in patients with chronic venous diseases (CVD) of C6 class using photodynamic therapy (PDT).
Methods. One hundred and twelve patients with ulcer (class C6) have been examined. All patients subjected to ultrasonic dopplerography and angiographic scanning on the diagnostic apparatus Aloka 4 and Logiq 7. TU planimetry was done using standard contact technique. Photodynamic therapy was applied in 67 (59,8%) patients. Photodynamic therapy was carried out using a semiconductor laser with the application of photosensitizing agents Radahlarin (0,1% gel) on trophic ulcers. Photodynamic therapy efficacy was controlled by means of classical microbiological and cytological methods checking dynamics of microbial spectrum, the level of contamination and regenerative processes in tissues. 45 (40,2%) patients of the 2nd group have been treated by standard methods. 59 (88,1%) patients of the 1st group and 43 (95,6%) – of the 2nd group have been operated on. A combined phlebectomy together with a free autodermoplasty by a splitted skin graft has been performed. Assessment of long-term results of combined treatment was carried out within 3 years.
Results. There was a marked reduction in microbial growth and microbial dissemination level from 107-108 up to 104-105 registered in the 1st group on the 4th day after use of photodynamic therapy; inflammatory and regenerative cytograms type was revealed in 73% of observations (p<0,05). In the 2nd group the prevalence of inflammatory and regenerative cytograms type (76%) was achieved on the 20th day. Photodynamic therapy application permitted to reduce the preoperative period by 3 folds and to carry out autodermoplasty of TU on the 5,1±0,8th days in the 1st group. Complete engraftment of autodermotransplant was observed in 74,6% of patients in the 1st group and in 46,5% – in the control group.
Conclusion. Photodynamic therapy appears to be effective, pathogenetically substantiated non-invasive method of local treatment as well as optimization of preoperative preparation of trophic ulcers in patients with CVD (С6 clinical class). Photodynamic therapy is considered to manifest marked antibacterial effects and improve microcirculation and epithelialization.

Keywords: photodynamic therapy, chronic venous diseases, venous trophic ulcers, lower extremities, microcirculation, antibacterial effects, epithelialization
p. 182-188 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".
Nasyrov M.V. A head of the operative unit of clinics of SBEE HPE "Samara State Medical University".
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