СОВРЕМЕННЫЕ СТАНДАРТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ВЕНОЗНЫХ ТРОФИЧЕСКИХ ЯЗВ НИЖНИХ КОНЕЧНОСТЕЙ

Abstract

Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standard sare proposed. The main aim of surgical therapy is the elimination of the lower extremity venous refluxso that the solution of this problem significantly reduces the incidencerate ofrecurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemicalablation(MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplastywith free split perforatedcutaneousflap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery(SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous refluxin the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation.