Surgical Treatment of Post-Burn Trophic Ulcers and Cicatrices of the Foot Calcaneal Area
Annotatsiya
The term ‘plantar’ ulcer was introduced by Price in 1959 and was defined as a chronic ulceration of the anaesthetic sole of the foot, situated in well-defined areas overlying bony prominences, resistant to local or systemic therapy and characterized by a marked tendency to recurrence. First time Grabb & Argenta (1981) offered the graft, with blood supply from the artery malleolaris anterior that makes it possible to close the affected zone with limited lesions. Some authors prefer Blair-Brown grafts (Vihriev & Belonogov, 1978). Initially, Elshahy (1978) had used the local skin and fatty graft, prepared on the lateral or medial surface of ankle joint. According to Amarante et al. (1986), good results were achieved with plasty of defects in the area of the Achilles tendon and with skin-fascial graft on the distal base from medial surface in malleolus. Shakirov et al., (2009) offered the L-form skin and fatty graft in the case of trophic ulcers in the post-burn wounds of this calcaneal area. The feature of the clinical course of so – called sandal burns that occurred in the past in some in mountain areas of Middle Asia, where primitive heating devices –sandals, were used, is noteworthy (Shakirov, 2004). Sandal burns are characterized by such severe deep injuries because of a close contact plantar of the foot with ash of coals or woods and include not only skin injuries of various depths but also injuries to underlying tissues: subcutaneous fat, fascia, muscles, and even bones (Shakirov & Tursunov, 2005). The burn trauma of the posterior surface of talus area and ankle joint with the following formation of cicatrix is often complicated by unhealing trophic ulcer. Ulcerous cicatrices located in the Achilles tendon zone are constantly traumatised on walking with shoes on, because the area of the tendon adjoining the talus on the surface of the support. As a result, ulcers gradually increase and cicatrices become rough and deep. The wound fundus gets a grey staining and the margins become dense without granulation and with signs of epithelisation. In spite of a large number of methods used, the problem of elimination of extensive defects in a zone of the Achilles tendon is not solved to the end. The study of features of skin structure, blood supply and innervations’ of the talus area showed