ОСОБЛИВОСТІ ЗАСТОСУВАННЯ ПЕРФОРАНТНОГО РЕВЕРСІЙНОГО КЛАПТЯ НА СУРАЛЬНІЙ АРТЕРІЇ ДЛЯ РЕКОНСТРУКЦЇЇ ПОКРИВНИХ ТКАНИН НИЖНІХ КІНЦІВОК
Abstract
To assess operative outcomes of laparoscopic surgery in colorectal cancer.Materials and methods: This is the outcome of treatment of colorectal cancer patients who were managed in the abdominal surgery department of "VOKOD" from April 2015 to April 2016, and underwent laparoscopic surgery for their treatment. All the patients had histopathological confirmation of their diagnosis. The patients received preoperative preparation and subsequently definitive surgery.A total of 25 patients (10 males and 15 females) had laparoscopic surgery within the period under review. The median age was 62.33±2.27 years. There were 9 resections of the sigmoid colon, 6 low anterior resections, 2 left-sided hemicolectomies , 6 rightsided hemicolectomies, 2 resections of the rectosigmoid colon.Results: 9% of patients had Grade I, 62% had Grade II and 29% had Grade III disease according to histopathological grade. The stage of disease was classified using Dukes classification; Dukes A-14%, Dukes B-27%, Dukes C-54%, Dukes D-5%. The average duration of surgery was 197.6±10.9 min with average blood loss of 110 ±19ml. The rate of conversion to laparotomy was 8%. There was no complication of anastomosis and no mortality during the study. Patients had significantly reduced postoperative pain, less postoperative trauma with an earlier restoration of bowel function and rehabilitation.Conclusions: Our initial experience shows that the use of laparoscopic-assisted interventions on colonic and rectal malignant neoplasms is reasonable and appropriate and results in fewer postoperative complications (in agreement with published literature), reduce the severity of pain and decrease requirements for opioid analgesics. Laparoscopic techniques allow performance of surgical intervention in compliance with all the principles of cancer surgery, providing the necessary volumes and clear resection margins. Based on improving medical technology and experience, the duration of laparoscopic surgery will approach that of traditional laparotomy with improvements in quality and long-term results.
References
Пшениснов К.П. Принципы реконструкции нижней конечности // Избранные вопросы пластической хирургии.–2003.– Т. 1, № 9.– 48 с.
Yilmaz, Mustafa M.D., Karatas, Ozlem M.D., Barutcu, Ali M.D. The distally based superficial sural artery island flap: Clinical experiences end modifications // Plastic and reconstructive surgery.– 1998.– Vol. 102 (7).– P. 2358-2367.
Masquelet A. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves. Anatomical study and clinical experience in the leg / A. Masquelet, M. Romana, G. Wolf. // PlastReconstr Surg. – 992. – Vol. 89. – P. 1115–1121.
The distally based sural flap / [K.E. Follmar, A. Baccarani, S.P. Baumeister et al.] // PlastReconstr Surg. – 2007. – Vol.119. – P. e138 – 148.
Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications / [Nakajima H, Imanishi N, Fuknsumi S, et al.] // PlastReconstr Surg. – 1999. – Vol.103. – P.104- 120.
Слесаренко С.В. Использование «сурального» кожно-фасциального лоскута на дистальном основании для замещения раневых дефектов нижней конечности / С.В. Слесаренко, П.А. Бадюл // ХірургіяУкраїни. - 2008. - №1(25).- С.44-50.
Batchelor J. S. A reappraisal of axial and nonaxial lower leg fascial flaps: an anatomic study in human cadavers / J.S. Batchelor, A. McGuinness // PlastReconstr Surg. – 1997. – Vol. 97. – P. 993-1000.
Al-Qattan M. A modified technique for harvesting the reverse sural artery flap from the upper part of the leg: inclusion of a gastrocnemius muscle “cuff” around the sural pedicle / Al-Qattan. // Ann Plast Surg. – 2001. – Vol.47. – P. 269–274.
Al-Qattan M. Lower limb reconstruction utilizing the reverse sural artery flap–gastrocnemius muscle cuff technique / M. Al-Qattan // Ann Plast Surg. – 2005. – Vol. 55. – P.174-178.
Distally-based superficial surgical flap: advantages of the adipofascial over the fasciocutaneous flap / [Parod P., De Biasio F., Coradro E. et al.] // Scand J Plast Hand Surg. – 2010. – Vol.44. – P.37-43.
Al-Qattan MM. The “central” approach for single-stage debulking of the reverse sural artery fasciomusculocutaneous flap / M.M. Al-Qattan // Ann Plast Surg. - 2007 – Vol. 59. – P.225-2
