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Aim: to assess topographic features and technical aspects of perforant veins ligation in patients with trophic disorders due to varicose disease., Results: There were 13-16 perforant veins of anterior tibial group and 3-8 veins of posterior tibial group which were predominantly localized along Linton line. Also there were 4-6 perforant veins of peroneal group. Postoperative control revealed that 41.63% of veins were missed during surgery regardless method of ligation. Anatomical analysis showed that relationship with deep fascia cruris is determinant factor for errors and dangers of remote ligation of perforant veins and creates high risk of deep vein injury. One of available method to avoid errors during ligation is thorough examination of the wound and use of Turner-Warwick test to confirm dissection of perforant vein and its incompetence. 100% effect of ligation was achieved in all cases after this test. Perforant veins ligation is single pathogenetic treatment for varicose disease class C4-C6. Perforant veins should be ligated under visual control. Intraoperative tests are also advisable.

The in vivo study on 25 rabbits and clinical study, involving 60 patients with lower limbs' varicose disease and trophic ulcers was carried out. The in-vivo study was based on the chemical distruction of the sympathic trunk by injecting 95% ethanol and 6% phenol paraneurally along the vascular bundle in the ear. The regeneration of the sympathic neural trunk was registered within 2-3 months after the injury. In human patients the US-guided chemical desympathization led to the increase of the capillary circulation (1.9 times at rest and 0.3 times under the load) during 2 months. The fact favoured the faster regress of inflammatory process in the ulcer.

Subfascial perforant veins dissection (SPVD) of the lower leg was performed in patients with chronic venous insufficiency CEAP class 5 and 6. 252 operations were performed in 236 patients. All patients had trophic lesions (skin hyperpigmentation and lipodermatosclerosis) 218 (92,4%) patients had trophic lower leg ulcer to the time of operation. 30 patients had earlier performed phlebectomy. Open SPVD was performed in 122 cases, endoscopic technique was used in 114 patients. Comparative analysis of these two methods was performed. Long-term results were accessed with the use of SF-36 questionnaire. Efficacy, pathogenetic validity and economic expedience of SPVD by large trophic lower leg ulcers are confirmed by the decrease of postoperative complications and recurrence rate. The horizontal venous reflux elimination and trophic ulcer dissection with intraoperative skin plasty allow a significant improvement of treatment results.

Endoscopic subfascial dissection was performed in patients with chronic venous insufficiency of CEAP class 4-6. 76 surgeries were performed in 68 patients. Mean age of the patients was 56 years. The causes of chronic venous insufficiency were varicose (37) and postthrombotic diseases. Trophic ulcers were in 46 patients. Thirty patients underwent earlier various phlebectomies, including Linton's surgery (6 patients). In 33 patients endoscopic subfascial dissection of venous perforants was combined with various phlebectomy, in 37 patients -- with excision of ulcer with following autodermoplasty few days after surgery. Endoscopic subfascial dissection was carried out with special surgical R.Wolf endoscope with 6 mm instrumental canal, and also standard laparoscopic optical devices "Olympus". Complications during surgery were seen in 2 patients: bleeding in subfascial space (1.3%) and perforation of tissues in ulcer zone (1.3%). In postoperative period long (up to 14 days) lymphorrhea and suppuration of surgical wound were in 2 (2.6%) patients. It is concluded that endoscopic approach is optimal for elimination of pathological reflux through venous perforants in complicated forms of chronic venous insufficiency of the lower extremities, including trophic ulcers resistant to treatment.

Results of an open randomized study of staged treatment of 94 patients suffering from varicose veins of the lower extremities with open infected trophic ulcers of the shank were analyzed. All the patients were divided into 3 groups depending on the treatment variant. Based on this study, clinical efficacy of early correction of upper vertical venous-venous reflux is substantiated. Efficacy of CO(2) laser application for sanation of trophic venous ulcers and practical importance of their auto-venous plastic reconstruction are demonstrated. Thus, up-to-date technologies provide differential treatment in patients with trophic venous ulcers.

The experience in surgical treatment of 326 patients with IV-VI degree chronic lower limb venous insufficiency (CEAP) is analyzed. Correction of disorders of venous hemodynamics was performed with surgical methods and sclerotherapy. The best clinical and functional results in long-term period were achieved in patients undergone surgery in an early stage of the disease without deep veins valves insufficiency and external trophic disorders. Pathology of deep veins required correction of valves function. It is concluded that these patients require complex approach to the treatment.

The method of treatment of varicose and hypertensive trophic ulcers with dura mater of cattle and pigs is developed. It is demonstrated that the method is effective and has advantages over known methods of local treatment.

Comparative analysis of elimination of blood regurgitation via crus communicant veins in varicose disease complicated by trophic disorders (lipodermal sclerosis and trophic ulcers) was carried out in two groups of patients. In groups 1(120 cases) routine Cocett's and Linton's operations with long stripping of venous trunks were performed. In group 2 (68 cases) minimally-invasive methods--distant communicantectomy and partial stripping--were used. Surgical techniques, short- and long-term results are described. In group 1 there were 26.6% of wound complications and 60% of crus neuropathies in remote period. In 2 group operations were performed 4 times faster, with insignificant blood loss, accompanied by primary adhesion and early discharge of patients. Period of temporary disability in these patients was less than in group 1, rate of neuropathies was 5.8%.

Cryostabilized boric-hydrocortisone aquaeous mixture was used in combined treatment of varicose trophic ulcers complicated by eczema and dermatitis in 70 patients. The gauze bandages, moistened by this mixture were used locality in preoperation period. In carrying out cutaneous plastic operation a free graft was preliminarily kept in the mixture for 5-7 min. During postoperation days the bandages were applied daily up to complete healing of the cutaneous flap, only upper layers of the bandage being changed. After the patient was discharged from the hospital the courses of boric-hydrocortisone applications were repeated 3-4 times for the first year. Bacterio-cytolodical examinations were carried out. The effectiveness of the use of the mixture was determined manifested by reduction of the duration of preoperative preparation and by improvement of longterm results.

In 36 patients with varicose-trophic ulcers of the lower extremities with marked allergic and autoimmune components use of low frequency ultrasound through 0.02% solution of chlorhexidine and 0.2% cyclophosphamide made it possible to diminish allergic dermatitis and eczema after 5 or 7 procedures. The ulcers cleaned in 8-13 days (sometimes, in 14-18 days). In 27 patients surgical correction of venous blood flow was performed after the sanatation and autodermoplasty of the ulcers. There were no recurrences in the long-term period (up to 2 years).

On the basis of treatment of 247 patients with the postthrombophlebitis syndrome and varicose veins of the lower limbs (72 of the patients underwent operation) the authors established that the course of these diseases is graver in elderly and old-aged patients than in younger patients. Old-aged patients tolerate, typical surgical interventions on the veins fairly well if they are subjected to careful preoperative management and systematic treatment in the postoperative period. Nonoperative treatment is very important and is effective in individual choice of the therapeutic measures. Prevention of allergic complications and normalization of the immune and regeneratory properties of the patient's organism are important elements of treatment.

The article deals with the experience in surgical treatment of 157 patients with chronic venous insufficiency complicated by trophic ulcers of the leg. Purposeful study of the method of two-stage operative treatment of trophic ulcers of the lower extremities of venous origin was conducted. The expediency of dividing the operation into two stages is substantiated on basis of analysis of the results. One-stage operation was carried out in 77 and two-stage operation in 80 patients. In the group of patients treated by one-stage operation 7 (9.8%) had suppuration of the postoperative wounds. No suppuration of wounds was encountered in patients who were operated on in 2 stages. Among 51 patients who underwent one-stage operation 4, (7.8%) had a recurrence of the disease. A recurrence of the disease (trophic ulcer) was not revealed in 57 patients treated by two-stage operation.

Examination of 307 patients with trophic and sluggish wounds showed that the use of a focussed carbohydrate laser beam with an energy density of 800-1000 J/cm2 makes it possible to remove pyonecrotic masses and microbial flora from the wound surface in one-stage, rapidly, without bleeding and without injury to the underlying healthy tissues and, in most cases, to make it sterile. A defocused beam of this laser applied locally with an energy density of radiation ranging from 0.5 to 2.5 J/cm2 produces a marked stimulating effect on processes of reparative regeneration in the irradiated tissues and allows one in this way to reduce the term of wound healing and the term of the patient's hospital stay by 1.4 times.

Pre- and postoperative treatment was conducted in 140 patients with trophic ulcers in a controlled abacterial medium in the period from 1985 to 1988. The etiological factor of the development of the trophic ulcer was primary varicosity in 86 (61.4%) and the post-thrombophlebitic syndrome in 54 (38.5%) patients. Venous hemodynamics improved both on the healthy and on the affected extremity. Besides, there was a tendency towards a decrease of the blood proteolytic activity near the focus of affection and an increase of that in the peripheral blood.

Comparative analysis of outpatient treatment by means of pulsed complexly-modulated electromagnetic field (PCMEMF) applied after phlebectomy in 30 patients with varicosity of the lower limbs showed the expediency of this type of treatment in the postoperative period. Exposure of the operated on limb to PCMEMF raises the efficacy of the rehabilitation measures and reduces the terms of the patients' temporary incapacity.

The article analyses the results of treatment of trophic ulcers of the lower extremities consequent upon chronic venous insufficiency in 199 elderly patients. Concomitant diseases were encountered in 82% of patients, which called for a differential approach to the choice of the method of treatment. Combined laser therapy in the system of complex treatment in 83 patients proved to be highly effective.

The efficacy of prolonged epidural blockade and hyperbaric oxygenation in the complex treatment of varicose ulcers of the lower limbs was studied in 112 patients. When applied separately and in combination, prolonged epidural blockade and hyperbaric oxygenation facilitate the improvement of the immediate and late-term results of treatment and reduce the period of hospitalization of the patients.