METHOD OF TREATING SECONDARY LOWER LIMB LYMPHEDEMA OF STAGE II-III Russian patent published in 2015 - IPC A61B17/00 A61H9/00 A61M25/00 

FIELD: medicine.

SUBSTANCE: limb surgery is preceded by a diagnostic study. That is followed by surgical thoracic duct cannulation with providing continuous external lymph excretion. The lymph excretion is accompanied by daily gradual mechanical lymph compression therapy of the limb followed by using a special surgical corset individually tailored of linen and profiled according to the enlarged limb with a number of adhesive stabiliser bands ensuring tight fixation of the surgical corset. A session of the mechanical lymph compression therapy is followed by recycling high and very high toxic lymph; as the excreted lymph toxicity decreases, a lymphoplasmapheresis is performed with lymphoplasmasorption and reinfusion of the purified lymph through a catheter in the vein inserted during the thoracic duct cannulation. If the lymph appears to be non-toxic, it is re-infused into an internal jugular immediately. The mobile fat folds formed on a shin and foot after the active drainage therapy are excised under general anaesthesia up to a fascia: on the shin from internal and anterior-external surfaces only, and on the foot - along an external lateral surface transferring onto a posterior surface, and along an internal surface below the ankle. The lymph excretion is performed for the whole postoperative period. Two days before the patient is discharged from hospital, the thoracic duct cannula is preserved by forming an internal lymphovenous bypass between the thoracic duct cannula and internal jugular catheter and positioning it subcutaneously. The next course of the above treatment is performed depending on the limb oedema intensity, postoperative scar condition and reparative process activity; that is preceded by surgical removal of the lymphovenous bypass from under the skin, separation thereof and lymph efflux recovery under general anaesthesia for the purpose of continuous lymph excretion and reinfusion into the vein. The mechanical lymph compression therapy continues until the mobile fat folds are formed. The newly formed excessive skin and subcutaneous fat together with the existing postoperative scar is excised under general anaesthesia up to the fascia. Once the treatment is completed, the thoracic duct cannula and internal jugular catheter are removed. After the patient is discharged from hospital, conducting the compression therapy and wearing compression garments are required.

EFFECT: method provides the high clinical effectiveness until the functional state of the limb and its appearance are recovered with no risk of recurrence.

10 cl, 15 dwg