Medicinski vjesnik, Vol. 32 No. (1-4), 2000.
Professional paper
Surgical treatment of leg ulcers
Vladimir Lehner
Janko Hančević
Krešimir Čandrlić
Krešimir Pinotić
Abstract
The paper discusses surgical treatment of hypostatic ulcers. The introductory part reviews their incidence and differential diagnostics as opposed to other kinds of lower extremities' ulcers, stressing contemporary understanding of the effect of hypoxic blood to the
lower leg musculature. A brief historical overview is given of the operating procedures important for contemporary clinical practice, the discovery of the function of the lower leg venous pump and consequent pathological changes in the crural venous blood flow. Graduated compressive therapy in the conservative treatment of hypostatic ulcers is presented. The authors describe an older classification of venous ulcers according to their etiology, which they consider more plausible. Insufficient perforators' operating procedures and techniques are reviewed, with an additional description of the role of Kuster's perforators. The article further diagnostic methods to detect valvular insufficiency of the deep venous system. Operating procedures on venous valves are described as well transposition operating procedures and transplantation of the brachial vein into the popliteal vein. Finally, the article discusses surgical treatment of post-thrombotic syndrome, presenting the surgical by-pass of the occluded plevic veins and the inferior vena cava. Indications for the implantation of PTFE prostheses are given, which proved most adequate in modern venous surgery. The importance of artificial arteriovenous fistulas is emphasized in keeping the flow through the by-pass. The pathogenesis of and surgical treatment of congenital venous valves of the inferior vena cava are described, a rare condition which, if not recognized, can be lethal even in children. Finally, clinical symptoms, incidence and diagnostic methods for the detection of the Cockett's syndrome are presented. Due to its importance in venous pathology, the authors state a brief development of medical knowledge important for the understanding as well as the most common surgical technique for the treatment thereof.
Keywords
Hrčak ID:
190498
URI
Publication date:
1.12.2000.
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