Novosti
Khirurgii
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Year 2014 Vol. 22 No 2

CASE REPORTS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.239   |  

P.N. MYSHENTSEV, S.E. KATORKIN

TACTICS IN THE TREATMENT OF LOWER LIMB SECONDARY LYMPHEDEMA

SBEE HPE Samara State Medical University,
The Russian Federation

Objectives. To evaluate the effectiveness of tactics of diagnosis and treatment in patients with the lower-limb secondary lymphedema.
Methods. During 5 years 58 patients with the lower-limb secondary lymphedema (IV stage) were being monitored. Ultrasound scanning, volumetry, computed tomography and clinical analysis of movements were applied during the examination combined with clinical and laboratory studies. The staged operative interventions were carried out in patient on the complex conservative treatment background. Life quality was estimated by means of the questionnaire SF-36 Health Status Survey (Russian version).
Results. The presented observation of the patient shows that on the first stage of treatment, the use of lymphotropic and prolonged intramuscular antibiotic therapy, the series of plasmapheresis and ultraviolet blood irradiation resulted in a stable remission in the recurrent erysipelas. Surgical intervention by creating lymphoveinous anastomosis to correct a lymphatic drainage proved to be ineffective. Volumetry and computed tomography performed at the next examination of the patient, permitted to specify a heavy, IV stage of the disease. In this regard, the patient underwent surgery of the modified tibia dermalipofascioectomy by Karavanov II. Five months later a reduction of functional failure of the affected limb and the increase of life quality have been approve. The reduction of the feeling of heaviness in the leg and quickly relieve symptoms have been registered. Volumetric measures of lower limbs made up 20477 cm3. Computed tomography showed a decrease in the soft tissue thickness of the left shin up to 26 mm, and the preservation of their density at the level of -26 HU.
Conclusions. Computer tomography plays a significant role in determining the disease stage and choice of a diagnostic optimal treatment tactics. At all stages of the disease a systematic complex treatment is indicated. A surgical correction such as the lymphoveinous shunting is considered to be possible in patients with the initial stages. Resection is recommended in the case of the 3rd, especially 4th stage of lymphedema.

Keywords: lymphedema of the lower limbs, computer tomography, surgical treatment
p. 239 243 of the original issue
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Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, d. 165 b, Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika gospital'noi khirurgii,
e-mail: katorkinse@mail.ru, Katorkin Sergei Evgen'evich
Information about the authors:
Myshentsev P.N. PhD, an associate professor of the hospital surgery chair and clinic of SBEE HPE Samara State medical University.
Katorkin S.E. PhD, an associate professor of the hospital surgery chair and clinic of SBEE HPE Samara State medical University.
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