PECULIARITIES OF DEBRIDEMENT AND PLASTIC INTERVENTIONS IN PATIENTS WITH STAGE IV CHRONIC LOWER LIMB ARTERIAL INSUFFICIENCY AFTER SUCCESSFULLY ENDURED VASCULAR RECONSTRUCTION

S.V. Lisin
Chair of General Surgery of the Paediatric Faculty, Municipal Clinical Hospital №4,
State Educational Facility of Higher Professional Education "Russian State Medical University under the Federal Agency on Public Health and Social Development",
Moscow, Russia

The authors analyzed the outcomes of surgical management of 88 patients presenting with stage IV chronic lower limb arterial insufficiency (CLLAI), who had underwent reconstruction of the major arteries over the period from 2002 to 2005.

The work was aimed at determining the optimal terms of carrying out debridement and plastic interventions with successful vascular reconstruction in patients with stage IV CLLAI.

Following direct revascularization, all the patients were found to have a drastic increase in die regional arterial hemodynamics in the affected lower extremity. Microcirculation of soft tissues and intraosseous blood flow were assessed by means of laser Doppler flowmetry and scintigraphy of the lower limb, respectively, to reveal that the ischaemic lesion of soft tissue of the lower extremity was irreversible in 9.1% of the patients, while in the remaining 90.9% of cases, the ischaemic lesion of microcirculation of the distal portions of the lower limb was of severe, however, reversible pattern, being restored averagely 30 days after arterial reconstruction.

The patients with the irreversible lesion of the distal portions of the lower extremity should simultaneously with arterial reconstruction be subjected to amputation at the level of the upper third of the crus with the primary suture of the wound. The optimal terms of the debridement and plastic interventions in severe reversible ischaemia and coagulation necrosis of the lower limb was noted to be day 30 following correction of the major blood flow. For the patients with colliquative destruction of tile distal portion of the foot, in order to decrease pyoseptic complications, the debridement intervention seems best to perform simultaneously with vascular reconstruction by the guillotine method followed by open management of the wound.

KEY WORDS: stage TV chronic lower limb arterial insufficiency, necrectomy, amputation.

P. 137

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