VACUUM THERAPY AS A PART OF THE SURGICAL TREATMENT OF PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY, COMPLICATED WITH TROPHIC ULCER
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i1.8613Keywords:
vacuum-therapy, chronic venous insufficiency, trophic ulcers.Abstract
Introduction. 25 % of patients with varicose veins have complications in the form of trophic ulcers. The presence of a trophic ulcer requires the surgeon to conduct appropriate preoperative preparation, which directly increases the material costs and the length of stay of the patient in the hospital.
Aim: To substantiate the use of vacuum therapy in a complex with surgical treatment of varicose veins complicated by a trophic ulcer at the preoperative stage.
Material and Methods. For preoperative preparation in 77 patients with chronic venous insuffi y III (CEAR C6) vacuum therapy for trophic ulcers was used. To substantiate the use of vacuum therapy, a study was made about its eff
on the healing of a trophic ulcer, the state of its bacterial contamination, the intensity of the pain syndrome and the length of stay in the hospital. After cleaning the wounds, a polyurethane sponge was used to measure the pore size depending on the phase of its healing, thus during the infl phase, a polyurethane sponge with a maximum pore size of 1500- 2000 μm and a mode (-300) mm Hg was used. During the proliferation phase, a sponge with a pore size of 500 to 1500 microns and a negative pressure (-150) mm Hg was used whiles at the healing phase, when there is maturation of the scar tissue and wound epithelization, a sponge with a pore size of up to 500 microns in a mode (-100) mm Hg was used.
Results. An analysis of the effectiveness of vacuum therapy has shown its benefits in terms of the timing of purification or healing over traditional treatments and a significant reduction of operating days.
After healing of trophic ulcers or a significant reduction in their size, all patients were treated with endovascular laser ablation of the varices – transformed veins of the lower extremities. In 19 patients, the technique of suprafascial laser coagulation of perforated veins under ultrasonic diagnostics was used and in another 23 patients subfascial endoscopic dissection of perforated veins was performed. At the same time in 19 other patients, autodermoplastics of trophic ulcer was used.
Conclusions. 1. Application of vacuum therapy in the complex of surgical treatment of patients with varicose disease of the lower extremities, complicated with trophic ulcer is a modern and non-alternative treatment method. As our studies show, reduces the pain syndrome, as well as the number of microbial bodies and wound exudation that is greatly accelerates the development of granulation tissue and stimulation of epithelization.
2. Application of vacuum therapy as a preoperative preparation shortens the duration of stay of patients with venous insufficiency complicated with trophic ulcer in the hospital.
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