Sokolov O. Differentiated approach to surgical treatment of varicose veins of the lower extremities with trophic ulcers of the calf

The dissertation is devoted to optimization of results of diagnostics and surgical treatment of patients with varicose veins of the lower extremities in stage C6 by applying a modified algorithm of diagnosis and treatment. The work is based on comparison and evaluation of the results of elimination of pathological superficial venous reflux (RA against venectomy) and subsequent local treatment of ulcers (method of autovenous plastics against treatment of ulcers under bandages) in 128 patients. The results of the elimination of reflux by RA and venectomy were comparable in the frequency of recurrences (9.7 ± 5.0% and 10.8 ± 4.3%, p> 0.05), while RA showed advantages in terms of postoperative pain in the limb ( 1.2 ± 0.8 vs. 4.7 ± 2.8 VAS points, p <0.05), complications (4.7 ± 1.3% vs. 12.3 ± 1.4%, p <0.05 ) and quality of life indicators. The use of autovenous ulcer plastics led to a decrease in pain in it (2.8 ± 0.9 vs. 6.6 ± 2.1 VAS points, p <0.05), infectious complications (6.2 ± 0.6% vs. 22, 4 ± 7.2%, p <0.05), acceleration of healing time (0.4 ± 0.2 vs. 0.2 ± 0.2 cm2 per day, p <0.05), granulations (4.3 ± 1.6 vs. 6.1 ± 2.1 days, p <0.05) and epithelialization (27.7 ± 7.3 vs. 44.5 ± 12.6 days, p <0.05) compared with topical treatment ulcers under bandages. The obtained data substantiated the expediency of modifying the algorithm of diagnosis and treatment of patients with varicose veins of the lower extremities in stage C6, taking into account the need for a rational combination of methods for the elimination of superficial venous reflux and local treatment of ulcers. After comparing the effect of treatment in groups without and using the original algorithm, it was found that its use accelerated the healing time of venous ulcers, reduce postoperative pain in the extremities and ulcers, improve the quality of life of patients.