Babynkina I. Surgical treatment of decompensated forms of chronic venous insufficiency of the lower extremities, taking into account the correction of phlebohemodynamic parameters

Dissertation for the degree of candidate of medical sciences in the specialty 14.01.03 "Surgery" (222 - Medicine). - Kharkov Medical Academy of Postgraduate Education, Ministry of Health of Ukraine, Kharkov, 2021. The study is based on the study of the results of surgical treatment of 102 previously operated patients with post-thrombophlebitic disease of the lower extremities in the decompensated stage of CVI (C4-6 classes according to CEAP) with insufficiency of the leg perforating veins. Depending on the method of eliminating low horizontal veno-venous shunt, the patients were divided into two groups: the main group consisted of 52 (51%) patients who underwent subfascial dissection of incompetent perforating veins from a mini-access; the comparison group included 50 (49%) patients who underwent endoscopic dissection of incompetent perforating veins. Most often, perforating veins were localized in the Cockett zone (in 75.5-85.4% of patients) and in the middle third of the lower leg along the posterior-inner surface (in 30.5%). One-stage, individualized surgical tactics with the proposed intervention on the SSV; subfascial dissection of perforating veins from a mini-access in combination with various options for eliminating vertical reflux, with intraoperative sclerotherapy and paratibial fasciotomy was performed in patients with multiperforating insufficiency of all fascial sheaths and a diameter of perforating veins of 5-6 mm or more, for persons with recurrent lymphedema of 1 degree and suffering from , as well as patients with tunnel (tourniquet) syndrome and sclerosis of subfascial spaces. The developed technique allows to achieve regression of trophic disorders, to reduce the number of wound suppuration from 4.0% to 1.9%, to avoid the development of hematomas and lymphatic complications and, in combination with methods of plastic wound closure, to accelerate the epithelialization of wounds. The use of the developed surgical tactics for the treatment of patients with PTFB made it possible to reduce the length of hospital stay from (8.3±2.87) to (6.29±0.3) days (p<0.01), reduce the number of postoperative complications in the early postoperative period from 14% to 3.8% (р<0.01), achieve good and satisfactory results in 82.6% of patients in the long-term period, and avoid recurrence of trophic ulcers. Key words: chronic venous insufficiency, trophic ulcers, post-thrombophlebitic, varicose veins.