Differentiated approach to surgical treatment of patients with chronic ischemia of the lower limbs

Purpose. To improve the results of surgical treatment of patients with chronic ischemia of the lower limbs caused by arterial bed distal involvement due to differentiated using the techniques of indirect revascularization. Materials and Methods. The study performed in 63 patients (89 ischemic limbs). Treatment performed using three types of surgical interventions: revascularization of bone split by distraction, repeated osteoperforation, the technique of prolonged tunnelization of lower limb bones with the Ilizarov fixator applied and simultaneous wire insertion into the medullary canal. 155 surgical interventions performed in total. The following methods used: clinical, transcutaneous polarography, ultrasound dopplerography, laser flowmetry, high-frequency ultrasound dopplerography. Results. The use of indirect revascularization techniques led to the increase of capillary blood flow, the development of collateral blood supply with the humeromalleolar index increase or stabilization, the improvement of tissue respiration. Differentiated approach to using indirect revascularization techniques allowed to obtain positive results in 76.9-85.5 % of cases. Conclusion. As the results have confirmed, the character of surgical impact should be adequate to the nosologic form and pathologic process severity in order to achieve a positive effect of treatment. The differentiated approach to surgical impact on bone and soft tissues results in ischemia compensation and contributes to lower limb saving.