PHLEBOLOGY ACCORDING TO THE THEORY OF PERFORASOMES (Part II)

The study was devoted to characteristics of blood supply of the skin in the lower extremety areas passage branches large and small saphenous veins. The choice of these areas was due to the known trophic disorders in the soft tissues of the lower third of the leg, occurring in patients with chronic venous insufficiency, the severity of which depends not only on anatomical prevalence of the process, but also the arterial system state due to paravasal fibrosis along the deep veins of the leg and the main artery. Anatomical study od perforator arteries in 42 fresh cadaver lower Вопросы реконструктивной и пластической хирургии № 3 (58) сентябрь’2016 Байтингер В.Ф., Соловцова И.А., Кочиш А.Ю. limbs of 26 dead adults showed that in the lower third of the medial surface of the thigh, particularly in the area of the medial malleolus, the number of perforating skin vessels extending from the posterior tibial artery is significantly greater than in the middle third of the thigh. They pass into the subcutaneous tissue between the medial edge of the Achilles tendon and the flexor tendons of the foot. According sonography, leaving the skin proximal to the tip of the medial malleolus Koсkett perforating veins in the subfascial and intrafascial areas are accompanied by 1-2 arteries and nerve trunks from n. saphenous. For accompanying structures characterized by their relative positions in parallel. This fact was confirmed intraoperatively in step ligation of perforating Koсkett veins. When varicose disease in the decompensation stage with the formation of trophic ulcers on the medial surface of the lower third of the leg perforating veins Kockett had a very large diameter (5 mm), causing compression extravasal accompanying artery and nerve. Small subcutaneous vein of the leg for a long distance runs in the fascial channel Pirogov, so call it “subcutaneous” is not entirely correct. Skin perforator artery in the back of the leg are a group of “indirect” because branches are muscular arteries supplying the posterior group of leg muscles. In the upper and middle third of the leg, they go under the skin chaotic, as branches of the posterior tibial artery. The lower third of these are mostly skin peroneal artery branches. Perforating veins connecting the small branches of the saphenous vein with the deep veins of the lower leg (gastrocnemius, soleus, posterior tibial) are a group of “indirect” because they did not connect them directly with the deep veins of the lower leg. This occurs indirectly, through their muscle tributaries. Feature indirect perforating veins posterior surface of the tibia is that the accompanying artery perforator veins extend at an angle to each other. In addition, these veins do not accompany the nerve trunks of n. suralis. Thus, the “favorite” localization of venous trophic ulcers on the medial surface of the lower third of the leg may be due to compression extravasal accompanying perforating veins and arteries of sensitive branches n. saphenous, and the compression of “legs” of perforasoms due to paravasal fibrosis along the deep veins of the leg and the main artery. This anatomy is no match on the back of the leg, in the small saphenous vein pool. There perforating veins are “indirect”, under the influence of the contractile function of the calf muscles. Hammer cutaneous arteries outside of these anatomical relations as forming the “legs” of the system perforasomov peroneal vessels.

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