Repeated Revascularizing Osteotrepanation in Patients with Critical Ischemia of the Upper and Lower Extremities with Distal Lesions of the Arteries
Kosayev JV* and Taghi-zade GT
Scientific Center of Surgery named after academician M.A.Topchubashov, Baku, Azerbaijan
*Corresponding Author: Kosayev JV, Scientific Center of Surgery named after academician M.A.Topchubashov, Baku, Azerbaijan.
Published: July 30, 2025
Abstract
Purpose: To study the results of repeated revascularizing osteotrepanation in patients with critical ischaemia of the upper and lower extremities in order to prevent major amputations. Material and methods: The etiological cause of the development of CI was thromboangiitis obliterans (OT) in 9 patients, Raynaud's syndrome (disease) in 4 patients, obliterating atherosclerosis in 5 patients, obliterating atherosclerosis with concomitant type 2 diabetes mellitus in 9 patients. According to the Fontaine-Pokrovsky classification, 10 patients had stage III of chronic ischemia, and 17 patients had stage IV of chronic ischemia. The terms of repeated revascularizing osteotrepanation are from 3 months. up to 2 years after the first ROT. Results: Repeated operation of oral rotation of the ulna and radius was performed in 15 extremities with stage IV chronic ischemia. In 3 (20.0%) extremities, the necrotic wound on the fingers healed, in 5 (33.3%) soft tissue necrectomy was performed, in 7 (46.7%) cases - minor amputations at the level of the fingers. Amputation at the level of the forearm was not performed. Repeated operation of tibial rot was performed in 24 limbs with stage IV chronic ischemia. In 7 (25.9%) limbs, the necrotic wound healed, in 6 (22.2%) limbs, soft tissue necrectomy was performed, in 9 (33.3%) limbs - minor amputations, in 5 (18.5%) - due to the progression of critical ischemia, amputation was performed at the level of the upper third of the tibia (major amputation). In 22 (81.5%) cases with stage IV chronic ischemia, the supporting function of the limb was preserved. Conclusion: With repeated ROT, the frequency of high amputations of the upper and lower extremities decreases. Out of 22 limbs with stage IV of chronic ischemia of the lower extremities, 15 (81.5% of cases) managed to preserve the supporting function. In all 20 cases with stage IV chronic ischemia of the upper extremities, it was possible to maintain the functional state of the limb.
Keywords: arterial steno-occlusion; critical ischemia; stimulation of regional circulation; re-vascularizing osteotrepanation
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