РЕВАСКУЛЯРИЗАЦИЯ НИЖНЕЙ КОНЕЧНОСТИ НА ОСНОВЕ КОНЦЕПЦИИ АНГИОСОМЫ С РАННЕЙ ЛОКАЛЬНОЙ РЕКОНСТРУКЦИЕЙ ЛОСКУТА "КЛИНИЧЕСКИЙ СЛУЧАЙ#

А.А. Кучай; А.Н. Липин; Н.Р. Карелина; Л.Ю. Артюх

REVASCULARIZATION OF LOWER LIMB BASED ON THE ANGIOSOME CONCEPT WITH EARLY LOCAL FLAP RECONSTRUCTION "A CASE REPORT#

A.A. Kuchai Saint Petersburg State Pediatric Medical University. Lithuania 2, Saint Petersburg, Russian Federation, 194100
A.N. Lipin Military Medical Academy named after CM. Kirov. st. Academician Lebedev, 6, Saint Petersburg, Russian Federation, 194044
N.R. Karelina Saint Petersburg State Pediatric Medical University. Lithuania 2, Saint Petersburg, Russian Federation, 194100
L.Yu. Artyukh Saint Petersburg State Pediatric Medical University. Lithuania 2, Saint Petersburg, Russian Federation, 194100

Keywords:

реваскуляризация ангиосома клинический случай анатомия артериальное кровоснабжение нижняя конечность revascularization angiosome clinical case anatomy arterial blood supply lower limb

Abstract

Lower extremity wounds are a healthcare issue that can result in debilitating consequences. Peripheral arterial occlusive disease (PAOD) being a major contributing factor to the disease, advance revascularization procedures (Angioplasty) based on the angiosome concept has been established in the literature to improve blood supply and promote better healing outcomes. We present a case of a 61-year-old lady with background of hypertension, diabetes and PAOD, was diagnosed with a non-healing foot wound with exposed metal implant. She had targeted angioplasty done based on angiosome concept followed by early local flap reconstruction for coverage, which healed well without complications. Although free tissue transfer has now been the mainstay for lower limb reconstruction with the advancement in microsurgery. Local flaps remain in the armamentarium of lower extremity reconstruction with small to medium sized wound defects. This case demonstrates the advantage of proceeding with immediate-early local flap reconstruction following successful targeted revascularization.

References

Макаров Л.М., Иванов Д.О., Поздняков А.В. и др. Компьютерная визуализация результатов биомедицинских исследований. Визуализация в медицине. 2020; 2(3): 3–7.

Мартов А.Г., Мазуренко Д.А., Климкова М.М. и др. Двухэнергетическая компьютерная томография в диагностике мочекаменной болезни: новый метод определения химического состава мочевых камней. Урология. 2017; 2: 98–103. DOI: https://dx.doi.org/10.18565/urol.2017.2.98-103.

Романова М.Н., Жила Н.Г., Синельникова Е.В. Сонографическое исследование периферических нервов при травмах верхних конечностей у детей. Педиатр. 2014; 5(3): 64–6. DOI: 10.17816/PED5364-66.

Ульрих Э.В. Вертебрология в терминах, цифрах, рисунках. СПб.: ЭЛБИ-СПб; 2002.

Andrea Speziali, Matteo Maria Tei, Giacomo Placella et al. Postpartum Sacral Stress Fracture: An Atypical Case Report, Case Reports in Orthopedics. 2015. Article ID 704393, 4 pages, 2015. https://doi.org/10.1155/2015/704393.

Beckmann N.M., Chinapuvvula N.R. Sacral fractures: classification and management. Emerg Radiol. 2017; 24: 605–17. DOI: 10.1007/s10140-017-1533-3.

Blake S.P., Connors A.M. Sacral insufficiency fracture. Br J Radiol. 2004; 77(922): 891–6. DOI: 10.1259/bjr/81974373. PMID: 15483007.

Elizabeth R. Benjamin, Dominik A. Jakob, Lee Myers et al. The trauma pelvic X-ray: Not all pelvic fractures are created equally, The American Journal of Surgery. 2022; 224(1, part B): 489–93, ISSN 0002-9610, https://doi.org/10.1016/j.amjsurg.2022.01.009.

Hackenbroch C., Riesner H.J., Lang P. et al. AG Becken III der Deutschen Gesellschaft für Unfallchirurgie. Dual Energy CT — a Novel Technique for Diagnostic Testing of Fragility Fractures of the Pelvis. Z Orthop Unfall. 2017; 155(1): 27–34. English. DOI: 10.1055/s-0042-110208.

Henes F.O., Nüchtern J.V., Groth M. et al. Comparison of diagnostic accuracy of Magnetic Resonance Imaging and Multidetector Computed Tomography in the detection of pelvic fractures. Eur J Radiol. 2012; 81(9): 2337–42. DOI: 10.1016/j.ejrad.2011.07.012.

Josephine Berger-Groch, Darius M. Thiesen, Dimitris Ntalos et al. Determination of bone density in patients with sacral fractures via CT scan, Orthopaedics & Traumatology: Surgery & Research. 2018; 104(7): 1037–41. ISSN 1877-0568. https://doi.org/10.1016/j.otsr.2018.07.022.

Rodrigues-Pinto R., Kurd M.F., Schroeder G.D. et al. Sacral Fractures and Associated Injuries. Global Spine Journal. 2017; 7(7): 609–16. DOI: 10.1177/2192568217701097.

Santolini E., Kanakaris N.K., Giannoudis P.V. Sacral fractures: issues, challenges, solutions. EFORT Open Rev. 2020; 5(5): 299–311. DOI: 10.1302/2058-5241.5.190064.

Schicho A. et al. Pelvic X-ray misses out on detecting sacral fractures in the elderly — Importance of CT imaging in blunt pelvic trauma. Injury. 2016. http://dx.doi.org/10.1016/j.injury.2016.01.027.

Urits I., Orhurhu V., Callan J. et al. Sacral Insufficiency Fractures: A Review of Risk Factors, Clinical Presentation, and Management. Curr Pain Headache Rep. 2020; 24(10). https://doi.org/10.1007/s11916-020-0848-z.

Yasuaki Tamaki, Akihiro Nagamachi, Kazumasa Inoue et al. Incidence and clinical features of sacral insufficiency fracture in the emergency department, The American Journal of Emergency Medicine. 2017; 35(9): 1314–6, ISSN 0735-6757, https://doi.org/10.1016/j.ajem.2017.03.037.

REFERENCES

Makarov L.M., Ivanov D.O., Pozdnyakov A.V. i dr. Komp’yuternaya vizualizaciya rezul’tatov biomedicinskih issledovanij [Computer visualization of biomedical research results]. Vizualizaciya v medicine. 2020; 2(3): 3–7. (in Russian).

Martov A.G., Mazurenko D.A., Klimkova M.M. i dr. Dvukhenergeticheskaya komp’yuternaya tomografiya v diagnostike mochekamennoy bolezni: novyy metod opredeleniya khimicheskogo sostava mochevykh kamney [Dual-energy computed tomography in the diagnosis of urolithiasis: a new method for determining the chemical composition of urinary stones]. Urologiya. 2017; 2: 98–103. DOI: 10.18565/urol.2017.3.98-103. PMID: 28845947. (in Russian).

Romanova M.N., Zhila N.G., Sinel’nikova E.V. Sonograficheskoe issledovanie perifericheskih nervov pri travmah verhnih konechnostej u detej [Sonographic study of peripheral nerves in upper limb injuries in children]. Pediatr. 2014; 5(3): 64–6. DOI: 10.17816/PED5364-66. (in Russian).

Ul’rih E.V. Vertebrologiya v terminah, cifrah, risunkah [Vertebrology in terms, figures, figures]. Sankt-Peterburg: ELBI-SPb Publ., 2002. (in Russian).