Subcutaneous paratibial fasciotomy in the treatment of chronic venous ulcer

Abstract

Background/Aim. Chronic venous ulcer (CVU), a disease of high incidence, is one of the most serious chronic venous insufficiency complications. It has been estimated that there are 1%-2% of adults with CVU deriving a high social significance. The aim of this study was to, using the clinical experience, determine the influence of subcutaneous paratibial fasciotomy (SPF) on the course and the treatment outcome of CVU. Methods. From February 2006 to September 2009 SPF was applied in a group of 43 patients treated for CVU along with other standard methods of treatment, and its influence on the course of ulcus cruris was followed up regarding the control group of another 43 patients treated with standard methods with no paratibial fasciotomy. Results. In the group of patients treated with SPF there was a significantly better clinical course of ulcus cruris closing as compared with the group of patients in which this method was not applied. In the group with paratibial fasaciotomy there was no Thiersch skin transplant rejection recorded nor ulcus recurrence within a 6-month after-surgery period, while in the control group there was Thiersch skeen transplant rejection in 11 patients, and ulcus recurrence in 9 patients within the same period. Conclusion. SPF is a useful method with a favorable influence on better clinical course of ulcus cruris closing, reducing recurrence rate and improving local microcirculation in the affected region. Operation act itself is safe, requires no specific equipment nor special training of the team of surgeons, thus being applicable to the majority of patients with ulcus cruris indicated for surgery.Uvod/Cilj. Hronicni venski ulkus spada u oboljenja visoke incidencije i predstavlja jednu od najtezih komplikacija hronicne venske insuficijencije. Procenjuje se da u odrasloj populaciji od hronicnog venskog ulkusa boluje 1-2% osoba, sto ima veliki socijalno-ekonomski znacaj. Cilj ove studije bio je da se kroz klinicko iskustvo utvrdi uticaj supkutane paratibijalne fasciotomije na tok i ishod lecenja hronicnog venskog ulkusa. Metode. Od februara 2006. do septembra 2009. godine, u okviru lecenja hronicnog venskog ulkusa, u grupi od 43 bolesnika primenjena je supkutana paratibijalna fasciotomija uz ostale klasicne metode lecenja, a, potom, pracen je njen uticaj na klinicki tok ulkusa krurisa u odnosu na drugu grupu od 43 bolesnika kod kojih su primenjene klasicne metode lecenja bez paratibijalne fasciotomije. Rezultati. U grupi bolesnika u kojoj je primenjena supkutana paratibijalna fasciotomija doslo je do znatno povoljnijeg klinickog toka zatvaranja ulkusa krurisa u odnosu na grupu bolesnika kod kojih ova metoda nije primenjena. Kod bolesnika iz grupe sa paratibijalnom fasciotomijom nije doslo do neprihvatanja koznog transplantata po Tirsu, niti do recidiva ulkusa u periodu od sest meseci nakon operacije, dok je kod kontrolne grupe doslo do neprihvatanja transplantata po Tirsu kod 11 bolesnika, a kod devet do recidiva ulkusa u prvih sest meseci postoperativno. Zakljucak. Supkutana paratibijalna fasciotomija predstavlja korisnu metodu koja utice na bolji klinicki tok zatvaranja ulkusa krurisa, smanjuje stopu recidiva i omogucava poboljsanje lokalne mikrocirkulacije u pogodjenoj regiji. Sam operativni akt je bezbedan, ne zahteva posebnu aparaturu niti specijalnu obuku hirurskog tima, te kao takav primenjiv je kod najveceg broja bolesnika sa ulkusom krurisom koji su kandidati za operativno lecenje.