DOI: https://doi.org/10.22263/2312-4156.2019.1.46
Fedzianin S.D.1, Kovalenko A.A.1, Kamiandrouskaya A.A.1, Poluyanchik E.A.2, Denisenko A.G.1
Revascularizing automyelotransplantation in complex treatment for diabetic angiopathy of the lower limbs
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Vitebsk City Central Clinical Hospital, Vitebsk, Republic of Belarus
Vestnik VGMU. 2019;18(1):46-51.
Abstract.
Objectives. To develop the method of indirect revascularization of the lower extremities, based on the use of autotransplantation of bone marrow aspirate.
Material and methods. The method of indirect revascularization of the lower extremities based on the use of autoaspirate of the red bone marrow – revascularization automyelotransplantation (RAMT) has been developed and introduced. Under the local anesthesia a sternal puncture is performed using the needle of I.A. Kassirsky and the red bone marrow is sampled. Local anesthesia is performed at the point of injection of aspirates on the thigh and shin with the subsequent bone marrow aspirate replantation by its insertion into the thigh and shin muscles. An aseptic dressing is applied. 23 patients suffering from diabetes mellitus with chronic arterial insufficiency of the 3rd b-4th stages were operated on. In all cases there were no indications for performing reconstructive operations on the great vessels. Conservative treatment as well as local treatment of wounds were carried out according to generally accepted patterns. The control group consisted of patients (32 people) suffering from diabetes mellitus with chronic arterial insufficiency of the 3rdb-4th stage receiving only conservative treatment.
Results. In the early postoperative period all patients with the carried out RAMT showed positive results. It was possible to avoid high amputation of the lower extremities in 90,9% of patients at the time of observation up to 18 months. In the comparison group this index was 65,0% (p<0,05). There was an increase in the distance of painless walking. In the main group out of 18 patients trophic disorders disappeared after surgery in 3 cases and 5 patients had no negative dynamics. A good and satisfactory quality of life was noted by 92.3% of patients with the carried out RAMT.
Conclusions. The proposed method can be used for indirect revascularization of the lower extremities in the complex treatment of patients with diabetic angiopathy. The use of RAMT enabled the avoidance of high amputation of the lower limb in 90,9% of patients within the period of 18 months. A tendency towards the increase in the distance of painless walking and the improvement of life quality of patients was seen.
Key words: diabetes mellitus, indirect revascularization, chronic arterial insufficiency.
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Information about authors:
Fedzianin S.D. – Candidate of Medical Sciences, associate professor of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Kovalenko A.A. – Candidate of Medical Sciences, associate professor of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Kamiandrouskaya A.A. – lecturer of the Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Poluyanchik E.A. – medical specialist in ultrasound diagnosing, Vitebsk City Central Clinical Hospital;
Denisenko A.G. – Candidate of Medical Sciences, associate professor of the Chair of Pathological Anatomy with the course of Forensic Medicine, Vitebsk State Order of Peoples’ Friendship Medical University.
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Hospital Surgery with the courses of Urology & Pediatric Surgery. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Alina A. Kamiandrouskaya.
