A case of successful surgical treatment of a patient with lymphedema of lower limbs

Abstract

The importance of treatment of patients with lymphedema of lower limbs arises from difficulties in their medical and social rehabilitation. At the expressed stages of the disease resection surgical operations are indicated which present complicated interventions. In the work clinical observation of a 33 yearold female patient with IV stage of primary lymphedema of the right lower limb is presented. In the course of conservative treatment after a complex examination including volumetry, ultrasound, computed tomography, the patient was made dermalipofascioectomy using method of shave therapy. The operation of modified dermalipofascioectomy of the shin was performed by Karavanov II method under spinal anesthesia with use of mono and bipolar coagulation. At the stage of elimination of fibrotically changed tissue dermatome Acculan 3Ti (GA 670) was used with controlled ranges of thickness within 0.21.2 mm and width within 878 mm. Intraoperative loss of blood and lymph was 800 ml and was compensated for with crystalloid, colloid solutions and fresh frozen plasma in the volume of 600 ml. Active drainage of the region of the postoperative wound was conducted by Redon method within 1012 days. Postoperative period ran without complications, with improvement of the patient’s condition.

Clinical observation showed a positive role of application of shave therapy apparatus at the main stage of resection operations.

Keywords

lymphedema / surgical treatment / lower limbs

References

[1] Gorshkov SZ, Musalatov HA. Slonovost' konechnostej i naruzhnyh polovyh organov. Moscow: Medicina; 2008. (In Russ).

[2] Горшков С.З., Мусалатов Х.А. Слоновость конечностей и наружных половых органов. М.: Медицина, 2008.

[3] Potashov LV, Bubnova NA, Orlov RS, et al. Hirurgicheskaja limfologija. SaintPetersburg: SPbGJeTU «LJeTI»; 2002. (In Russ).

[4] Поташов Л.В., Бубнова Н.А., Орлов Р.С., и др. Хирургическая лимфология. СПб.: СПбГЭТУ «ЛЭТИ», 2002.

[5] Foldi M, Folfi E, Kubrik S. Textbook of Lymphology: for Physicians and. Lymphedema Therapists. Hardcover; 2007.

[6] Foldi M., Folfi E., Kubrik S. Textbook of Lymphology: for Physicians and Lymphedema Therapists. Hardcover, 2007.

[7] Doller W. Possibilities of surgical therapy of lymphedema. Wien Med Wochenschr. 2013; 163(78):17783.

[8] Doller W. Possibilities of surgical therapy of lymphedema // Wien Med. Wochenschr. 2013. Vol. 163, №78. P. 177183.

[9] Koshima I, Narushima M, Yamamoto Y, et al. Recent advancement on surgical treatments for lymphedema. Ann Vasc Dis. 2012;5(4):40915. doi:10.3400/avd.ra.12.00080

[10] Koshima I., Narushima M., Yamamoto Y., et al. Recent advancement on surgical treatments for lymphedema // Ann. Vasc. Dis. 2012. Vol. 5, №4. P. 409415. doi:10.3400/avd.ra.12.00080

[11] Lee BB, Kim YW, Kim DI, et al. Supplemental surgical treatment to end stage (stage IVV) of chronic lymphedema. Int Angiol. 2008;27(5):38995.

[12] Lee B.B., Kim Y.W., Kim D.I., et al. Supplemental surgical treatment to end stage (stage IVV) of chronic lymphedema // Int. Angiol. 2008. Vol. 27, №5. P. 389395.

[13] Bogachev VJu, Bogdanec LI, Zolotuhin IA, et al. Poslojnaja dermatolipjektomija (shavetherapy) pri dlitel'no nezazhivajushhih venoznyh troficheskih jazvah. Angiologija i sosudistaja hirurgija. 2003;9(4):6570. (In Russ).

[14] Богачев В.Ю., Богданец Л.И., Золотухин И.А., и др. Послойная дерматолипэктомия (shavetherapy) при длительно незаживающих венозных трофических язвах // Ангиология и сосудистая хирургия. 2003. Т. 9, №4. C. 6570.

[15] Hermanns HJ, Gallenkemper G, Kanya S, et al. Die ShaveTherapie im Konzept der operativen Behandlung des therapieresistenten Ulcus cruris venosum. Aktuelle L. Phlebologie. 2005; 34(4):20915. (In German).

[16] Hermanns H.J., Gallenkemper G., Kanya S., et al. Die ShaveTherapie im Konzept der operativen Behandlung des therapieresistenten Ulcus cruris venosum // Aktuelle L. Phlebologie. 2005. Vol. 34, №4. P. 209215.

[17] Sushkov SA, Kuhtenkov PA, Hmel'nikov VJa. Pervyj opyt primenenija poslojnoj dermatolipjektomii (shavetherapy) pri lechenii hronicheskoj venoznoj nedostatochnosti. Novosti hirurgii. 2007;15(1):537. (In Russ).

[18] Сушков С.А., Кухтенков П.А., Хмельников В.Я. Первый опыт применения послойной дерматолипэктомии (shavetherapy) при лечении хронической венозной недостаточности // Новости хирургии. 2007. Т. 15, №1. С. 5357.

[19] Katorkin SE, Mel'nikov MA, Kravcov PF, et al. Jeffektivnost' primenenija poslojnoj dermatolipjektomii (Shave Therapy) v kompleksnom lechenii pacientov s venoznymi troficheskimi jazvami nizhnih konechnostej. Novosti hirurgii. 2016;24(3):25564. (In Russ). doi:10.18484/ 23050047.2016.3.255

[20] Каторкин С.Е., Мельников М.А., Кравцов П.Ф., и др. Эффективность применения послойной дерматолипэктомии (Shave Therapy) в комплексном лечении пациентов с венозными трофическими язвами нижних конечностей // Новости хирургии. 2016. Т. 24, №3. С. 255264. doi:10.18484/23050047.2016.3.255

[21] Myshencev PN, Zhukov BN, Katorkin SE, et al. Znachenie komp'juternoj tomografii v ocenke stadii limfedemy nizhnih konechnostej. Novosti hirurgii. 2011;19(5):747. (In Russ).

[22] Мышенцев П.Н., Жуков Б.Н., Каторкин С.Е., и др. Значение компьютерной томографии в оценке стадии лимфедемы нижних конечностей // Новости хирургии. 2011. Т. 19, №5. С. 7477.

[23] Myshencev PN, Katorkin SE. Taktika lechenija pri vtorichnoj limfedeme nizhnih konechnostej. Novosti hirurgii. 2014;22(2): 23943. (In Russ).

[24] Мышенцев П.Н., Каторкин С.Е. Тактика лечения при вторичной лимфедеме нижних конечностей // Новости хирургии. 2014. Т. 22, №2. С. 239243.

RIGHTS & PERMISSIONS

Myshencev P.N., Katorkin S.E., Lichman L.A.