Chronic venous insufficiency (CVI) is one of the most common diseases in the world, occurring in 25-40% of the adult population of the industrialized countries of the world, severe forms of CVI (CEAP C3–C6) predominate and account for 17-20% (Mansilha, 2020) . According to an epidemiological assessment, varicose veins of the lower extremities (VEC) occur in 25-33% of women and 10-40% of men in the population (Nicolaides et al., 2018). In the Framingham study (Brand et al., 1988), varicose veins were diagnosed annually in 2.6% of women and 1.9% of men (Nicolaides et al., 2018). The prevalence of chronic venous disease of the lower extremities (CVHD) in women is 2.5-3 times higher than in men. Annual progression of CKD to a higher CEAP (Clinical-Etiology-Anatomy-Pathophysiology) class is noted in 4% with established concomitant cardiovascular insufficiency (Pannier & Rabe, 2012). Regardless of race, a direct relationship with genetic predisposition is also traced, it was found that 64.8% of patients with HCV have a mother and 13.9% a father (Pitsch, 2012). In Ukraine, the prevalence of HCVNC reaches 38% in women and 20% in men (Lupaltsov & Kitchenko, 2017). CVI was the cause of primary disability in 30.8% of patients who received it in 2017, of which 48.9% were persons of working age (Kosynskyi et al., 2019).
Chronic venous ulcer is a serious problem for the health care system, its prevalence is 5% among the population over 65 years of age (Hedayati et al., 2015; Kosulnikov et al., 2022). In the US, the average cost of treating one trophic ulcer is reported to be $15,732, and the average cost of surgery for non-healing ulcers is $33,907 (Ma et al., 2014). Costs for the treatment of CKD and its complications in the form of C6 clinical class are 2% of the budget allocated for health care in the European Union. About 7% of male patients of working age are forced to be on sick leave due to CVI at least once a year, which also leads to significant economic losses (Malte et al., 2020).
To date, there is no generally accepted treatment strategy for patients with C6 clinical grade CKD. In our opinion, this is due to the fact that this problem is a painstaking work of a surgeon and requires the use of various combinations of surgical interventions and a mass of pre-operative measures, which creates significant difficulties in everyday work. Adequate medical care not provided in a timely manner to this group of patients, in the following, leads to a high level of disability and loss of working capacity, which creates a serious socio-economic problem. The development of balanced local treatment and the adequate selection of surgical intervention methods depending on the ultrasound (US) picture will allow to achieve an increase in the quality of life, acceleration of the healing of wound defects, restoration of work capacity, reduction of disability, reduction of the duration of inpatient treatment and the rehabilitation period in this contingent of patients. Which certainly indicates the relevance of the chosen problem and the need to solve it.
The aim of our study was to develop the tactics of complex surgical treatment of patients with C6 clinical class HCV through the use of modern, pathogenetically based methods of local treatment of venous ulcers based on cellular technologies, modern wound dressings, local application of low pressure effects on trophic ulcers and the use of combinations of minimally invasive methods of elimination of venous ulcers reflux, in particular, with the use of high-frequency welding bipolar electrocoagulation.
In accordance with the goal, the following tasks are formulated:
1. To determine the reasons for the unsatisfactory results of the treatment of patients with clinical class C6 HCVNC.
2. To develop tactics for the use of minimally invasive surgical interventions and local treatment of trophic ulcers (TB) for the elimination of chronic venous insufficiency in patients with C6 clinical class.
3. To prove the effectiveness of the use of cellular technologies, in particular Platelet-Rich Plasma (PRP) in combination with NPWT (Negative Pressure Wound Therapy; VAK therapy), in the treatment of trophic ulcers, in patients with C6 clinical class CVN.
4. To compare the quality of life of patients with C6 clinical class HCV before and after the proposed complex surgical and local treatment of TB based on cellular technologies, negative pressure wound therapy (VAP) and minimally invasive surgical operations using high-frequency welding bipolar electrocoagulation.
5. To substantiate and study the effectiveness of the proposed complex surgical treatment of patients with C6 clinical grade CKD, by conducting immunohistochemical and pathomorphological studies of biopsies from trophic ulcers and establishing the rates of growth of mitotic activity, dynamics of regenerative processes.
