DEFINITION OF TREATMENT BY DEVITALIZATION
in the protocol for clinical tests
RNDr. Vratislav HorŠk, CSc
Attachment # 1 to the "Request for starting clinical
tests of devitalization technique in healing malign tumors" handed over to the Czech Ministry of Health by Drs. Fortżn and HorŠk on October 30,
Translation from the Czech original by Martin Tlusty.
Devitalization is: such a surgical procedure, which influences s p e c i f i c a l l y the
vascular system of certain organ or tissue, and results in closing of both
arterial and venous circulation. This way the tissue circulation is cut out
together with its supply by nutrition and oxygen. Devitalization displays at the
same time an analgesic effect, because the nerve endings are loosing
conductivity for the painful stimulus from the devitalized territory, due to its
Concerning performance of the Devitalization technique, it is
necessary to stress necessity of a concurrent obstruction of both, artery and
vein (or at least obstruction of one after another within the short time
period). By Devitalization it should never be meant: obstruction of the artery
only via its embolization, performed sometimes. This procedure causes an
arterial spastic contracture accompanied with the strong pain, in the influenced
area. The full obstruction of the blood circulation is not reached anyway,
because the venous reflux is sufficient for transport of a certain amount of
oxygenated blood, what leads to the partial survival of the tissue. Confusion of
embolization with Devitalization, which is sometimes indicated, combines thus
two, in fact different patho-anatomical and patho-physiological phenomena, which
have profoundly different effect on organism !
From the point of view of
indications for use of the Devitalization operation technique, it is necessary
to emphasize that the optimal situation is when Devitalization is performed r i
g h t away during the first operation (i.e. when the Devitalization treatment is
not postponed to the later time and to the relaparotomy).
The physical and
psychic condition of the patient is also important.
The condition, when the
tumor considerably expanded and multiple metastases occurred, are somewhat
reducing the hope for curative impact of Devitalization.
The situation, where
there is generalization of the tumorous process and creation of ascitus (at
carcinosis of peritoneum), is insolvable by Devitalization technique (as well as
by other curative methods used in the clinical practice).
technique will not be usable also at patients, who went through the previous
unsuccessful actino-therapy or chemotherapy. These treatments damage (besides
the tumor cells) also cells of the immune system, whose sufficiently high
functionality is essential for triggering the curative impact after application
of the Devitalization treatment.
Notes to the technique for performance
The operator must have a detailed anatomical knowledge
of the organ or tissue to be Devitalized. For accomplishment of devitalization,
the l i g a t u r e of blood vessels (both of arteries and of veins) may be
used. Also the devitalizating sutures (mattress sutures inserted specifically to
the exact place) obstructing reliably the nutritive vessels at the tumor base
(e.g. of melanoma).
In the case of hardly accessible, or extra large primary
tumor, the Devitalization treatment can be performed on the lymphatic nodes with
metastases (melanoma, carcinoma).
The insertable ligature is inserted at one
edge of the node. Then the node is circled by one thread, which is then knotted
after its firm tightening.
In the cases of metastases in the liver (e.g.
carcinoma) the Devitalization can be performed also by the mattress sutures,
which should involve the whole area of metastasis.
For performance of the
Devitalization treatment, only the non-absorbable suture material (silon,
oxsilon, or silk) should be used.