Treatment of patients with chronic arterial insufficiency and trophic ulcers of the lower extremities by using innovative, combined treatment and prophylactic complexes

Background: Diseases of the arteries of the lower extremities are a serious problem for public health. A significant increase in the incidence of chronic obliterating diseases of the arteries of the lower extremities indicates the need to revise and optimize existing treatment methods. Objective: To improve the treatment results for patients with chronic arterial insufficiency in the presence of a trophic tissue defect, reduce the recovery and healing time of trophic ulcers, and improve the quality of life of patients. Materials and methods: A study was conducted that included 71 patients aged 40 to 70 years, of both sexes, who underwent surgical treatment for mesh-occlusive lesions of the femoral-popliteal-tibial arterial segments with CAN IV (according to Fontaine-Pokrovsky). After randomly dividing into two equal groups, a one-stage surgical intervention was performed in the study group of 34 people using the author’s technique with reconstruction of the vascular component and closure of trophic ulcers. In the control group, 37 patients received standard treatment. Results: The main criteria for assessing the effectiveness of the treatment in both groups were the following: regression of ischemia to CAN I – CAN IIa; the number of anesthetic interventions in the first group; the rate and quality of healing of trophic defects. The median healing time in the main group was 13 (Q1-Q3 12.00–15.00) days, and in the control group – 16 (Q1-Q3 15.00–17.00). The median length of hospital stay in the control group was 15 (Q1-Q3 14.00–16.00) days with further transfer to the purulent surgery departments or to the outpatient stage to prepare wounds for surgical treatment. In the study group, the median hospitalization period was 10 (Q1-Q3 8.00–11.00) days. The results confirm the effectiveness of the applied combined surgical approach in the treatment of this category of patients. Conclusion: In the postoperative period, in patients who underwent surgical treatment for steno-occlusive lesions of the femoral-popliteal-tibial arterial segments with stage IV CAD (according to Fontaine-Pokrovsky), namely those who underwent combined surgery, focusing on the indicators of the absence of infectious complications in the postoperative period, the timing of the onset of healing of trophic ulcers, passed with fewer complications, less severe pain syndrome. A significant reduction in the duration of patient treatment, i.e. the stage of providing medical care in hospitals, was also confirmed. During the outpatient observation period, it was revealed that the timing and rate of healing in Group I were also more favorable. In patients of Group I who underwent combined surgery, more favorable treatment results were observed. This was manifested in the absence of infectious complications after surgery and a faster onset of healing of trophic ulcers. In addition, a significant reduction in the overall duration of inpatient treatment for these patients was noted. Positive dynamics were maintained at the outpatient stage, where patients of group I demonstrated shorter periods and a high rate of wound healing. These results confirm the effectiveness of the combined surgical approach used in the treatment of this category of patients.