PATHOGENETIC APPROACH TO THE TREATMENT OF WOUNDS AFTER AMPUTATION OF THE FOOT AGAINST THE BACKGROUND OF CHRONIC LIMB-THREATENING ISCHEMIA (CLTI)
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i4.15028Keywords:
Chronic threatening ischemia of the lower extremities, amputation of the foot, plasma enriched with growth factors, tyrosine kinase indexAbstract
SUMMARY. The strategy of treatment of chronic limb-threatening ischemia (CLTI) should be its timely revascularization and prioritization of performing "small" amputations on the foot.
The aim – to improve the healing of wounds after amputation of a part of the foot with the help of a biological membrane enriched with growth factors for their subsequent autodermoplasty
Material and Methods. 81 patients with IV grade CLTI were under observation according to the Fontaine classification (category 6 according to the Rutherford classification), with open wounds after amputation of a part of the foot due to dry gangrene. The average age of the patients was 56.7±9.3 years, all men. Patients underwent vasoballoon angioplasty of the arteries of the lower extremities. After that, amputation of the foot was performed using various methods. In connection with the shortage of skin flaps of the wound, 41 patients were treated by the open method, according to the traditional method, followed by autodermoplasty. In other patients (40 patients), to stimulate the reparative process, the entire area of the wound surface on the foot was covered with a plasma membrane (PRGF®-Endoret® supernatant), enriched with growth factors. To control the regeneration process, the tyrosine kinase index was calculated at different times of treatment (6-10 and 15 days after amputation). Also, the content of interleukins IL-1β, IL-4, tumor necrosis factor (TNF-α), interferon (IFN-γ) was determined. After that, the intercytokine coefficient (ICC) was calculated.
Result. In patients who underwent endovascular angioplasty and PRP therapy before limb amputation and closed the wound with a plasma membrane, ICC decreased below baseline. This can be explained by a significant increase in the level of anti-inflammatory cytokines against the background of a stable amount of pro-inflammatory factors. The reaction of IL-4 and IFN-γ can be regarded as preparation for the transition of the wound process to the proliferation stage, and the decrease in the levels of IL-1β and TNF-α reflects a decrease in the manifestations of the inflammatory reaction in the wound.
Conclusions: 1. Wound healing after foot amputation in patients with CLTI depends not only on restoration of blood supply to the limb. The healing process in an acute wound is largely controlled by the spatio-temporal action of growth factors, cytokines, and chemokines.
- The use of plasma membrane as a biological membrane enriched with growth factors (PRGF)-Endoret can be a new therapeutic strategy to accelerate the healing process of wounds after amputation of the foot on the background of CLTI with the purpose of subsequent autodermoplasty.
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