Vacuum therapy of trophic ulcer of lower extremities, presented in patients with DFS

Objective. To improve the results of treatment in patients, suffering decompensated forms of chronic venous insufficiency (CHVI) of the lower extremities, using introduction of biological necrectomy and vacuum-therapy in combination with complex of optimal surgical interventions, depending on state of venous hemodynamics of the lower extremities. Materials and methods. In 2015-2018 yrs in Surgical Clinic of the Zakarpattya Regional Clinical Hospital named after Andriy Novak 147 patients, ageing 40 yrs old and older, suffering CHVI Category C6 in accordance to the CEAP Classification, were treated. All the patients were divided into two groups: the Group I consisted of 76 patients, suffering CHVI in decompensated stage on background of varicose disease, and the Group II - 71 patients, suffering trophic ulcers (TU) on background of postthrombophlebitic syndrome (PTHPHS). Results. There was established, that the TU clearance under the action of maggot-therapy in patients, suffering decompensated course of CHVI, is significantly more effective, than under the impact of vacuum-therapy. Autodermoplasty must be performed in all the patients, having TU with 4 cm in diameter, Good and satisfactory results were observed in 75 (98.7%) patients of Group I and in 63 (88.7%) patients of Group II, while poor results - in 8 (11.3%) patients of Group II. The working capacity of patients, suffering CHVI in decompensated stage of varicose genesis, have enhanced in 16.5 times, while in the patients, suffering TU on background of PTHPHS – in 1.25 times. Conclusion. Combined treatment of CHVI in decompensated stage, occurring on background of varicose disease includes the TU clearance, using vacuum-therapy or biological necrectomy with subsequent elimination of vertical reflux. In the patients, suffering TU on the PTHPHS background the biologic necrectomy with elimination of horizontal reflux is advantageous. The working capacity in patients with CHVI in decompensated stage of varicose genesis have enhanced in 16.5 times, while in the patients with TU on the PTHPHS background - in 1.25 times.

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Lower Extremities Workbook Excerpts: Principles of Assessment: Excerpts from Guides Sixth Impairment Training Workbook-Lower Extremities

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.sepoct02 ◽

2009 ◽

Vol 14 (5) ◽

pp. 8-9

Keyword(s):

Lower Extremities

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Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2017.marapr01 ◽

2017 ◽

Vol 22 (2) ◽

pp. 3-5

Author(s):

James B. Talmage ◽

Jay Blaisdell

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Complex Regional Pain Syndrome ◽

Lower Extremities ◽

Pain Syndrome ◽

Upper Extremities ◽

Motor Deficits ◽

Type I ◽

Sixth Edition ◽

Nerve Entrapments

Abstract Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.

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