IS THE USE OF ALLOPLASTIC MATERIAL IN TIBIAL RECONSTRUCTIONS JUSTIFIED?

Balzer K., Guds I.M., Henyk S.N.
Clinic of Vascular Surgery, Evangelist Hospital, Mulheim-on-Ruhr, Germany,
Chair of General Surgery, Ivano-Frankovsk Medical Academy, Ivano-Frankovsk, Ukraine

107 patients (mean age 67.1±5.3 years) suffering from atherosclerosis obliterans of the lower limbs underwent tibial reconstructions using different type bypass grafts. Alloplastic material in the form of allograft or in combination with vein was employed in 80.4% of cases. A study was made of the effect of different postoperative factors on the bypass graft patency and the percentage of limb salvage within 10 years following operation. The cumulative bypass grafts patency was 68% by the end of the first year, 46% by the 5th year, and 42% by the 10th year. The postoperative lethality constituted 4.7%. Immediate thromboses occurred in 26.2% of patients. Another 31.4% of patients developed early occlusions (within one year). It has been established that the results of the use of the autologous vein combined with graft (Composite-Graft) are 13-20% better at different times as compared to the effect produced by the allograft itself. The study of bypass graft function as dependent on the site of the distal anastomosis has demonstrated that the best results were obtained with the peroneal artery and turned out worse with the anterior tibial artery. Administration of indirect action anticoagulants in the postoperative period conside-rably decreases the risk of limb loss. Therefore, in the absence of the autologous vein for calf artery reconstruction, alloplastic material (desirably of the Composite-Graft type) should be employed.

P. 89-94

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