A MULTIDISCIPLINARY APPROACH TO PERFORMING ENDOVASCULAR OPERATIONS AND ECONOMICAL FOOT AMPUTAIONS AGAINST THE BACKGROUND OF CHRONIC THREATENING ISCHEMIA OF THE LOWER EXTREMITIES (CLTI)

Abstract

The aim of the work: to determine the effectiveness of a multidisciplinary approach to the treatment of chronic threatening ischemia of the lower extremities associated with necrotic changes in the area of the foot. Мaterials and Methods. The results of the use of endovascular operations in 39 patients with CLTI IV class were analyzed according to the Fontaine classification (category 6 according to the Rutherford classification), with open wounds after amputation of a part of the foot due to dry gangrene and PRP and PRF therapy using the PRGF®-ENDORET® technology, according to the examination and conclusions of the multidisciplinary team. The control group consisted of 41 patients with a similar pathology and stage of the necrotic process, in the treatment of which no relevant specialists were involved, and the treatment of open wounds after amputation of a part of the foot due to dry gangrene was carried out according to traditional methods. The average age of the patients was 56.7±9.3 years, all men. A multidisciplinary team consisting of vascular surgeons, ultrasound specialists and angioradiologists, an interventional physician, an orthopedic surgeon, and functional diagnosticians was created for the specific treatment tactics of the above-mentioned patients. In order to determine the indications for performing small amputations on the foot, we performed a comprehensive assessment of the limb's blood supply after endovascular operations and the use of platelet-rich plasma.  Results and Discussion.The use of endovascular operations in combination with PRP and PRF has a positive effect on the blood supply in the ischemic limb. This is evidenced by: improvement of indicators of microcirculation, speed of blood flow, increase of local skin temperature on the foot, indicators of the Ankle Brachial Index. As our studies have shown, the activity of the tyrosine kinase system, as well as the peculiarities of the cytokine relationship, which is a reflection of the processes of alteration and proliferation in the wound, can be an objective criterion for skin autotransplantation on the wound surface. After consultation with an orthopedist, we performed amputation of the foot: according to Garangeau – in 10 patients, according to Chopar – in 51 cases, according to Lisfranc or Lisfranc-Haye in 19 patients. Due to the lack of skin flaps, the wounds were treated by an open method followed by autodermoplasty, except for 39 patients (after endovascular surgery and PRP therapy), who were stimulated on the 5-6th day after foot amputation with the help of a plasma membrane (PRGF supernatant) ®-Endoret®), enriched with a growth factor, which covered the entire area of the wound surface.