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Year 2016 Vol. 24 No 3
GENERAL & SPECIAL SURGERY
S.E. KATORKIN, M.A. MELNIKOV, P.F. KRAVTSOV, A.A. ZHUKOV, M.J. KUSHNARCHUK, A.A. REPIN
EFFICIENCY OF LAYER DERMATOLIPECTOMY (SHAVE THERAPY) IN COMPLEX TREATMENT OF PATIENTS WITH LOWER LIMBS VENOUS TROPHIC ULCERS
SBEE HPE "Samara State Medical University",
The Russian Federation
Objectives. To assess the efficacy of layer dermatolipectomy application in the complex treatment of patients with persistent refractory venous trophic ulcers.
Methods. The examination and combined treatment of patients C6 class (n=71) was carried out. The mean age was 62,3±7,1 yrs. Women dominated – 45 (63,4%). Duration of the venous ulcers composed 6,8±1,7 yrs. Phlebectomy (n=71) (crossectomy, short stripping on the hip, SEPS) was performed combined with a free autodermaplasty by the split perforated flap. Layer dermatolipectomy was carried out in the 1st group of patients prior to autodermoplasty. In the 2nd group of patients (n=36) shave therapy was not carried out. Statistical differences between the age groups (t=0,2; p=0,831), sex (χ2=0,008; p=0,993), nosology (χ2=0,004; p=0,995), anamnesis (t=0,14; p=0,891), duration (t=0,21; p=0,829) and the area (t=0,18; p=0,863) of the trophic venous ulcers were not recorded. Evaluation of long-term treatment results was carried out in the period from 1 to 12 months.
Results. Time of complete epithelialization of ulcers in the group I made up 31,4±4,7 days, in the group II - 49,4±7,2 days (t=2,09; p=0,044). In 27 (77,1%) patients in the group I a complete engraftment of autodermotransplant had occurred; in group II - in 7 (19,4%) patients (χ2=23,674; p=0.001). Epithelization of the partial graft necrosis (24,3±4,8 cm2) took place in 8 (22.9%) patients in group I at 42,4±4,5 days. In group II, partial necrosis (67,1±10,5 cm2) was in 29 (80,6%) cases, the lack of complete epithelialization was observed in 3 (8,3%) patients.
A statistically significant reduction in the malleolar volume of the affected leg in the 1st group (t±3,6; p±0,001) and in the 2nd group (t=2,2; p=0,035) was registered, more pronounced in the 1st group in 6 and 12 months (p<0,05).
Conclusion. Layer dermatolipectomy with autodermaplasty by the perforated flap and surgical correction of venous hemodynamic insufficiency is considered to be an effective treatment of chronic diseases of veins (C6 class). Shave therapy is the treatment of choice for persistent refractory venous trophic ulcers and lipodermatosclerosis of the lower limbs.
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443079, Russian Federation,
Samara, pr. Karla Marksa, d. 165 " b",
Kliniki Samarskogo gosudarstvennogo
kafedra i klinika gospitalnoy khirurgii.
tel. office 8 10 846 276-77-89,
Katorkin Sergey Evgenevich
Katorkin S.E. PhD, an associate professor, a head of the chair and clinic of hospital surgery of SBEE HPE "Samara State Medical University".
Melnikov M.A. PhD, an associate professor, a head of the vascular surgery department of the clinic of hospital surgery of SBEE HPE "Samara State Medical University".
Kravtsov P.F. PhD, a cardiovascular surgeon of the vascular surgery department of the clinic and assistant of hospital surgery chair of SBEE HPE "Samara State Medical University".
Zhukov A.A. A cardiovascular surgeon of the vascular surgery department of the clinic of hospital surgery chair of SBEE HPE "Samara State Medical University".
Kushnarchuk M.J. A cardiovascular surgeon of the vascular surgery department of the clinic of hospital surgery chair of SBEE HPE "Samara State Medical University".
Repin A.A. A cardiovascular surgeon of the vascular surgery department of the clinic of hospital surgery chair of SBEE HPE "Samara State Medical University".