INDIRECT REVASCULARIZATION OF THE DISTAL PARTS OF THE LOWER LIMB AT THE TERMINAL STAGES OF OCCLUSIVE-STENOTIC LESIONS OF ITS ARTERIES

Abstract

Background. The terminal stages of occlusive-stenotic lesions of the limb arteries, especially in the distal areas, are characterized by critical ischemia, the development of gangrenous lesions of parts of the limb, and despite the use of a number of medical and surgical methods, there is a threat of limb loss. An effective remedy in this situation is the removal of dead tissue, reliable closure of the defect with revascularization of ischemic tissue.
 Aim: to improve the results of treatment of patients with distal occlusive lesions of the lower extremity arteries by combined revascularization using free soft tissue flaps.
 Materials and methods. We studied 45 patients with terminal stages of occlusive-stenotic lesions of the distal lower extremities (lower legs and feet). Preliminary graft sizes were established after clinical and instrumental assessment of the volume of tissue deficiency in the recipient area. The expected size of the flap tissue transformation, which occurred in the long term after surgery, was also taken into account.
 Results. The effectiveness of the method was studied in the transplantation of 48 flaps in 45 patients with terminal limb arterial lesions. The used method ensures 90.5% of limb survival after 3 years; 81.0% of good results - walking with a cane.
 Conclusion. 1. The used method of treatment of limbs with terminal stages of occlusive-stenotic arterial lesions by indirect revascularization with a thoraco-dorsal flap is effective, provides 90.5% survival of the limb after 3 years. Preliminary graft sizes should be established after clinical and instrumental assessment of the volume of tissue deficiency in the recipient area, taking into account the size of tissue transformation. Combined revascularization of the lower extremities significantly improves the hemodynamics of the ischemic limb.