THE ROLE OF THE TOPOGRAPHIC ANATOMY OF THE LOWER EXTREMITY DURING MINIMALLY INVASIVE INTERVENTIONS FOR PURULOUS-NECROTIC COMPLICATIONS OF THE DIABETIC FOOT SYNDROME
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i3.14081Keywords:
diabetic foot syndrome (DFS), structure of the vascular bed of the foot, anatomical zones of minimally invasive approaches, deep phlegmon of the plantar surface of the footAbstract
SUMMARY. The aim – to improve the results of treatment of patients with purulent-necrotic complications of the diabetic foot syndrome by developing and using a minimally invasive method of surgical treatment. On the basis of the studied anatomical and topographic features of the structure of the vascular bed of the foot, identify convenient anatomical zones for performing minimally invasive approaches.
Material and Methods. In order to study the morphological characteristics and anatomic-topographic features of the soft tissue structures of the foot, an X-ray angiographic study of the arterial bed of the foot of 60 lower limbs of people aged from 45 to 67 years was conducted. There were no external injuries, injuries and diseases (acute or chronic) of the lower extremities in these patients, and there was no history of diabetes. After the vessels were contrasted, radiography of the studied area was performed in two projections – direct (plantar) and lateral.
In addition, we studied the arterial channel of 65 angiograms of the lower extremities of patients with ischemic and mixed forms of diabetic foot syndrome. The age of the investigated objects varied from 54 to 81 years.
The experimental study was carried out on 6 lower limbs of sick people aged 30 to 65 years. In the experiment, minimally invasive access and the possibility of endovideoscopic visualization of the soft tissues of the foot were developed.
For visualization during experimental interventions, a rigid Arthrex arthroscope with a diameter of 4 mm was used, the end of which has an oblique plane for observation at a viewing angle of 30 °. It is a rigidly connected tube and head consisting of a body, a fiber optic connector and a camera. An arthroscopic drainage cannula with a diameter of 5 mm was also used, which has several side holes and is equipped with a faucet, which allows maintaining and regulating the stable outflow of fluid from the cavity during the procedure.
As part of the clinical study, an analysis of the results of treatment of 8 patients with purulent-necrotic complications of DFS – deep phlegmon of the plantar surface of the foot – was carried out. In all patients, an anatomically based minimally invasive surgical method of treatment of purulent-necrotic complications of DFS developed by us was applied, which included: incision, sanitation and drainage of deep phlegmon of the plantar surface of the foot, step-by-step ultrasound treatment of wounds with endovideoscopic sanitation, flow-washing drainage and local treatment.
Results. The performed anatomic-topographical studies of the foot made it possible to obtain data on the morphological characteristics of soft tissue structures, to identify low-vascular zones, and to substantiate approaches for a minimally invasive method of treating patients with purulent-necrotic complications of the diabetic foot syndrome.
A minimally invasive method of treating patients with diabetic foot syndrome has been developed and implemented into clinical practice, and its advantages over conventional surgical methods of treating this disease have been proven.
The tactics of treatment of patients with different localization of purulent-necrotic complications of diabetic foot syndrome have been improved, which allowed to improve the results of treatment of patients of this category.
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