Venous diseases of the lower limbs that are accompanied by the development of trophic ulcers are among the medical and social challenges. The vast number of patients is in working age, from 30 to 65 years old. Severe forms of the disease are registered in 27% of the cases; active or healed trophic ulcers are diagnosed in 12.9 % of cases. At present special attention is being paid to the effective surgical treatment of the pathology, to the introduction of the latest surgical interventions, which provide complete radicalism about the causes of trophic ulcers of venous genesis and ensure the maximum cosmetic effect. The aim of this work is to analyze the scientific literature on using the latest surgical techniques in the treatment of venous pathology in patients with trophic ulcers of lower extremities to promote improving the existing and elaborate new surgical interventions in terms of this pathology. Nowadays surgical treatment of patients with chronic venous insufficiency of the lower extremities, especially in case of trophic leg ulcers can be considered as the stage of the integrated treatment of venous trophic disorders. Modern surgical interventions differ in the methods, techniques and tools used, but provide the maximum cosmetic effect and complete radicalism regarding the causes of chronic venous insufficiency. Correction of pathological venous-venous reflux is the main method of eliminating venous hypertension, which underlies the progression of chronic venous insufficiency and promotes the development of trophic disorders, including the ulcers formation. The etiological cause of venous trophic ulcer is the appearance of pathological reflux, which occurs in the superficial, deep and perforating veins and, accordingly, the place of surgery should be those venous segments in which the pathological process is diagnosed. The operation can be performed simultaneously or in two stages: first, the vertical venous-venous reflux is eliminated, followed by the correction of the horizontal reflux. When using modern minimally invasive technologies, adequate and complete correction of venous blood flow in the affected limb is performed simultaneously producing no serious tissue damages to avoid cosmetic effect and to lessen postoperative period. Thus, the analysis of the scientific literatures has shown the unity of views on the strategy of surgical treatment of varicose trophic ulcers that involves the elimination of vertical and horizontal reflux, but the absence of views unity on tactical approaches in solving these issues.

Suppurative and inflammatory processes in soft tissues make up a considerable share, 35 – 40%, in the structure of surgical problems in inpatients. Suppurative and inflammatory processes are often characterized as acute, resulting in systemic infection, sepsis, and even fatal outcomes. In the total structure of lethal outcomes in surgical inpatient departments the mortality rate due to acute surgical infection makes up 40 – 60%. Long hospital treatment, insufficient effectiveness of existing treatment methods, additional expenses for recovery and rehabilitation put this issue in the forefront of the most challenging healthcare tasks. This review states out that management of suppurative wounds is still remaining the most pressing for surgeons nowadays. Despite the rich experience and ever-increasing techniques and approaches in treating suppurative wounds, the elaboration of more effective physical methods to stimulate the healing of the wounds seems to be promising. The physical methods can include vacuum treatment, laser and ultrasound wound treatment, ozon therapy, hyperbaric oxygenation, phototherapy, hydropress sanation. The above methods can considerably contribute to the wound treatment thus promote its rapid healing. However, each of the techniques listed has its own disadvantages (technical, biological, economical), and can be applied only at a particular stage of wound healing. In-depth analysis of all advantages and shortcomings, contraindications to each method, enables to improve the treatment outcomes for patients with suppurative wounds thus reducing the time of hospital staying and expenses.

The aim: To analyze the occurrence of complications and evaluate the quality of life in patients who got less-invasive treatment methods using endovenous laser ablation of varicose veins of the lower extremities in the early and late postoperative periods. Materials and methods: The study was conducted with the participation of 100 patients treated in 2019-2020 by one team of surgeons for varicose veins of the lower extremities with symptoms of chronic venous insufficiency C2-C4 (CEAP classification). Depending on the performance of endovenous surgical interventions, all patients were divided into two study groups. Results: In assessing the quality of life associated with health, according to the CIVIQ 2 questionnaire, it was found that in the presence of varicose veins in the superficial veins of the lower extremities, indicators decrease both in general and on all studied scales (pain, physical, psychological and social). However, when using endovenous laser ablation without miniphlebectomy, after 6 months of observation, recurrence of varicose veins of the lower extremities was noted, which was not observed in patients of the first group. Conclusions: The use of less-invasive interventions with ultrasound guidance positively affects patients’ quality of life with varicose veins of the lower extremities, both in the early and prolonged postoperative periods.

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