Horný J
Chirurgické oddĕlení SZZ, Prostĕjov.
Rozhl Chir. 1996 Jan;75(1):38-40.
From extensive paratibial fasciectomies on account of crural ulcers W. Hach changed to subcutaneous fasciotomy from an incision 30 to 40 mm long with digital severing of the perforating veins. Its main effect is the creation of wide communication between the subfascial and suprafascial space. The subcutaneous tissue affected with lipodermatosclerosis rest on muscles well supplied with blood which can improve the trophics of surface tissues. The reduction of the surgical approach to 10 mm calls for special instruments. Instruments designed by the author proved useful. The author operated eight patients with advanced varicosis of the saphena maior with incompetence of two to three Cockett veins and with developed lipodermatosclerosis. After stripping of the saphena maior the smaller varicosities were extracted by dented strippers, haemostasis was ensured by tamponade by means of an applicator. Cockett's veins were interrupted in the subfascial layer from a paratibial incision in the middle of the leg by means of a 10 mm L-shaped chisel and straight chisel. This was followed by prolongation of fasciotomy by means of a fasciotome to the inner ankle. The postoperative course was devoid of complications with minimal pain, the cosmetic effect was excellent.
鉴于小腿溃疡，W. Hach从广泛的胫旁筋膜切除术改为皮下筋膜切开术，切口长30至40毫米，用手指切断穿静脉。其主要作用是在筋膜下间隙和筋膜上间隙之间建立广泛的连通。受脂性皮肤硬化影响的皮下组织位于血液供应良好的肌肉上，这可以改善表层组织的营养状况。将手术切口缩小到10毫米需要特殊器械。作者设计的器械证明很有用。作者对8例大隐静脉曲张晚期患者进行了手术，这些患者存在两到三条科克特静脉功能不全且伴有脂性皮肤硬化。在剥脱大隐静脉后，用带齿剥脱器抽出较小的曲张静脉，用敷料填塞确保止血。通过小腿中部的胫旁切口，用一把10毫米的L形凿子和直凿子在筋膜下层中断科克特静脉。随后用筋膜刀将筋膜切开术延长至内踝。术后过程无并发症，疼痛轻微，美容效果极佳。
