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

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.

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.

Author Biographies

V. I. Rusyn, Uzhgorod National University

Rusin Vasyl I, MD, DSci (Med), professor
Department of surgery diseases
Uzhgorod National University
88000, Ukraine, Transcarpathian region, Uzhhorod, Narodna Square, 3
+38 (0312) 61-35-70
kaf-surgery@uzhnu.edu.ua.
ORCID: https://orcid.org/0000-0001-5688-9951

V. V. Korsak, Uzhgorod National University

Korsak Viacheslav V, MD, DSci (Med), professor
Department of surgery diseases
Uzhgorod National University
88000, Ukraine, Transcarpathian region, Uzhhorod, Narodna Square, 3
+38 (0312) 61-35-70
E-mail: kaf-surgery@uzhnu.edu.ua.
ORCID: https://orcid.org/0000-0002-4866-1882

O. A. Nosenko, Uzhgorod National University

Nosenko Oleksii A, MD, PhD (Med), Assistant professor
Department of surgery diseases
Uzhgorod National University
88000, Ukraine, Transcarpathian region, Uzhhorod, Narodna Square, 3
+38 (0312) 61-35-70
E-mail: kaf-surgery@uzhnu.edu.ua.
ORCID: https://orcid.org/0000-0002-1645-0212

V. V. Rusyn, Uzhgorod National University

Rusyn Vasyl V, MD, DSci (Med), professor
Department of surgery diseases
Uzhgorod National University
88000, Ukraine, Transcarpathian region, Uzhhorod, Narodna Square, 3
+38 (0312) 61-35-70
E-mail: kaf-surgery@uzhnu.edu.ua.
ORCID: https://orcid.org/0000-0002-0794-6777

S. S. Kalinich, Uzhgorod National University

Kalinich Stepan S MD, postgraduate student
Department of surgery diseases
Uzhgorod National University
88000, Ukraine, Transcarpathian region, Uzhhorod, Narodna Square, 3
+38 (0312) 61-35-70
E-mail: kaf-surgery@uzhnu.edu.ua.
ORCID: https://orcid.org/0000-0001-8330-244x

References

Abreu A, Oliveira B. A study of the Unna Boot compared with the elastic bandage in venous ulcers: a randomized clinical trial. Revista Latino-Americana de Enfermagem. 2015;23(4):571-7. doi 10.1590/0104-1169.0373.2590.

Bradbury S, Walkley N, Ivins N, Harding K. Clinical Evaluation of a Novel Topical Negative Pressure Device in Promoting Healing in Chronic Wounds. Advances in Wound Care. 2015;4(6):346-57. doi 10.1089/wound.2014.0596.

Bush R, Brown K, Latz C. Compression therapies for chronic venous leg ulcers: interventions and adherence. Chronic Wound Care Management and Research. 2015;2:11-21. doi 10.2147/cwcmr.s62940.

Katorkin S, Zhukov A, Kushnarchuk M. Combined treatment of vasotrophic ulcers in lower limbs chronic venous insufficiency. Novosti Khirurgii. 2014;22(6):701-9. doi 10.18484/2305-0047.2014.6.701.

Lupahltsov VI, Kitchenko SS. Application of local vacuum-therapy in complex of treatment of trophic ulcers of the lower extremities, caused by chronic venous insufficiency. Klin khir. 2017;(9):52-4. doi 10.26779/2522-1396.2017.09.52. [In Ukrainian].

Marston W, Armstrong D, Reyzelman A, Kirsner R. A. Multicenter Randomized Controlled Trial Comparing Treatment of Venous Leg Ulcers Using Mechanically Versus Electrically Powered Negative Pressure Wound Therapy. Adv Wound Care (New Rochelle). 2015;4(2):75-82. doi 10.1089/wound.2014.0575.

McCulloch J. Venous Ulcers. JAMA Dermatology. 2015;151(9):1044. doi 10.1001/jamadermatol.2015.58.

Mihenko B, Babinets L, Mihenko L, Riabokon S. Trophic ulcers at posttrombophlebitic syndrome, modern approaches to patients’ treatment. Zdobutky klinichnoi i eksperymentalnoi medytsyny. 2016;(2):99-100. doi 10.11603/1811-2471.2016.v26.i2.6256. [In Ukrainian].

Venher I, Kostiv S. Obhruntuvannia sposobu tromboprofilaktyky u patsiientiv iz vysokym ryzykom rozvytku venoznykh tromboembolichnykh uskladnen. Shpytalna khirurhiia. Zhurnal imeni L Ya Kovalchuka. 2015;(1):56-9. doi 10.11603/1681-2778.2015.1.4514. [In Ukrainian].

Nelson E, Hillman A, Thomas K. Intermittent pneumatic compression for treating venous leg ulcers. Cochrane Database of Syst Rev. 2014;(5):CD001899. doi 10.1002/14651858.cd001899.pub4.

Yurkova R, Zadykhanov E. Vacuum therapy of trophic ulcer of lower extremities, presented in patients with DFS. Interactive science. 2017;(11):40-2. doi 10.21661/r-116318.

Izosimov V, Umerov E, Grivenko S. Clinical and biochemical aspects of complex therapy of complicated forms of chronic venous insufficiency of lower extremities. Chelovek i ego zdorove. 2017;(4):52-6. doi 10.21626/vestnik/2017-4/10. [In Russian].

Published
2019-07-07
How to Cite
Rusyn, V. I., Korsak, V. V., Nosenko, O. A., Rusyn, V. V., & Kalinich, S. S. (2019). Biological necrectomy and vacuum-therapy in complex treatment of decompensated chronic venous insufficiency of the lower extremities. Klinicheskaia Khirurgiia, 86(7), 32-35. https://doi.org/10.26779/2522-1396.2019.07.32
Section
General Problems of Surgery