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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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ORIGINAL ARTICLES  VASCULAR SECTION


The Journal of Cardiovascular Surgery 2003 April;44(2):249-53

lingua: Inglese

Chronic venous ulcer treatment with fascial pedunculated graft

Montisci R., Ruju C., Massoni G., Sanfilippo R., Brotzu G.

Depart­ment of Vas­cular and Tho­racic Sur­gery, Uni­ver­sity Poly­clinic Hos­pital, Uni­ver­sity of Cag­liari, Cag­liari, ­Italy


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Aim. ­Chronic ­venous ­ulcer treat­ment is ­often ­time con­suming and ­requires a ­high ­degree of com­pli­ance ­from the ­patient. ­This ­derives not ­only ­from ­venous hyper­ten­sion but ­also ­from ­chronic struc­tural and meta­bolic ­changes of under­lying tis­sues ­which ­impair the ­healing pro­cess. It there­fore ­becomes nec­es­sary to ­improve the ­ulcer ­tissue con­di­tion in ­order to accel­erate the ­healing pro­cess. ­This is ­obtained ­mainly ­with the improve­ment of ­local hae­mod­y­namics and sec­ondly by ­direct ­action on the ­ulcer. The aim of the ­study is to eval­uate the effi­cacy of a treat­ment ­with a pedun­cu­lated ­flap of ­fascia as an addi­tional treat­ment of ­chronic ­venous ­ulcer.
­Methods. ­Four ­patients clas­si­fied C6 ­according to the ­CEAP clas­sifi­ca­tion ­were ­treated for ­chronic ­venous ­ulcer ­with cor­rec­tion of ­venous hyper­ten­sion (saph­e­nec­tomy or lig­a­ture of incom­pe­tent per­fo­rating ­veins). The ­patients ­also under­went rota­tion of a fas­cial pedun­cu­lated ­flap trans­ferred ­from the ­sural ­area to the per­i­mal­le­olar ­area. ­After 7-15 ­days ­they had a ­free ­skin ­graft in the ­treated ­area.
­Results. All ­patients ­were dis­charged on the 3rd post­op­er­a­tive day ­after the ­flap rota­tion. In 3 ­patients the ­ulcer ­healed ­within 30 ­days and in a 4th ­patient ­within 45 ­days. No recur­rence was ­observed.
Con­clu­sion. ­With ­this ­method the ­healing ­time ­seems to be short­ened com­pared to the typ­ical evo­lu­tion in ­patients ­treated ­with ­only ­reflux con­trol fol­lowed by con­ser­va­tive ­therapy. Asso­ciating fas­cial ­flap in the treat­ment of ­chronic ­venous ­ulcers ­improves the bed on ­which the ­free ­skin ­graft is ­applied. We can ­also hypoth­e­size ­that ­this pro­ce­dure ­restores the apon­eu­rotic bar­rier ­between ­deep ­venous cir­cu­la­tion and super­fi­cial micro­cir­cu­la­tion ­with the ­ensuing improve­ment in ­local ­venous hyper­ten­sion.

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