
PURULENT-NECROTIC COMPLICATIONS AFTER AMPUTATION OF THE LOWER EXTREMITIES: ISSUES OF TREATMENT AND PREVENTION
Abstract
Transfemoral amputation of a limb performed by a patient with obliterating atherosclerosis with irreversible ischemia is a difficult, traumatic operation and is accompanied by high mortality. High mortality after amputation of a limb at the hip level is associated with the severity of the general condition of patients and complications of the postoperative period. As our studies have shown, the most common complication after limb amputation is an infection of the femoral stump wound, its development is directly related to metabolic disorders in patients, a decrease in the immune status, ischemia of the stump tissues and foci of secondary infection. The clinical picture of infection of the femoral stump wound is variable. It depends, first, on the patient's general condition, the process's spread, the trophism of the stump tissues, and the nature of the microflora. Improving the treatment results of patients who have undergone limb amputation is possible by performing all the necessary preventive measures regarding ischemia and stump infection in the prescribed volume and the development of infectious complications, as well as treatment by the requirements of modern purulent surgery.
Keywords
Hip amputations, obliterating atherosclerosis, ischemia
References
Chan YC, Cheng SW, Cheung GC. Predictors of restenosis in the use of helical interwoven nitinol stents to treat femoropopliteal occlusive disease. J Vasc Surg. 2015 Nov;62(5):1201-9.
Chen CK, Chang HT, Chou HP, Lee MH, Chen YC, Huang YC, Chen TJ, Chang HL, Shih CC. Alendronate and risk of lower limb ischemic vascular events: a population-based cohort study. Osteoporos Int. 2014 Feb;25(2):673-80.
Columbo JA, Ptak JA, Buckey JC, Walsh DB. Hyperbaric oxygen for patients with above-knee amputations, persistent ischemia, and nonreconstructable vascular disease. J Vasc Surg. 2016 Apr;63(4):1082-4.
Kauzlarić N, Sekelj-Kauzlarić K, Jelić M. Experience in the prosthetic supply of patients with lower limb amputations in Croatia. Prosthet Orthot Int. 2002 Aug;26(2):93-100.
Spinetti G, Cordella D, Fortunato O, Sangalli E, Losa S, Gotti A, Carnelli F, Rosa F, Riboldi S, Sessa F, Avolio E, Beltrami AP, Emanueli C, Madeddu P. Global remodelling of the vascular stem cell niche in the bone marrow of diabetic patients: implication of the microRNA-155/FOXO3a signalling pathway. Circ Res. 2013 Feb 1;112(3):510-22.
Traballesi M, Porcacchia P, Averna T, Angioni C, Lubich S, Di Meo F, Brunelli S. Prognostic factors in prosthetic rehabilitation of bilateral dysvascular above-knee amputee: is the stump condition an influencing factor? Eura Medicophys. 2007 Mar;43(1):1-6.
Umur L, Selçuk I. Prosthetic vascular graft management in above-knee amputations. Cardiovasc J Afr. 2022 Nov-Dec 23;33(6):313-316.
Vasilchenko EM, Tsoy VK, Dedikova TN, Baranov AI, Zoloyev DG, Zoloyev GK. Kriticheskaia ishemiia kul'ti bedra: chastota, klinicheskoe znachenie i diagnostika [Critical ischemia of hip stump. Incidence, clinical significance and diagnosis]. Khirurgiia (Mosk). 2018;(8):50-55.
Wilson JS, Miranda A, Johnson BL, Shames ML, Back MR, Bandyk DF. Vascular injuries associated with elective orthopaedic procedures. Ann Vasc Surg. 2003 Nov;17(6):641-4.
Zoloyev DG, Makarov DN, Baranov AI, Zoloyev GK, Vasilchenko EM. Piatiletniaia vyzhivaemost' i rezul'taty lecheniia khronicheskoĭ ishemii kul'ti bedra [Five-year survival and outcomes of chronic hip stump ischemia treatment]. Khirurgiia (Mosk). 2018;(11):35-38. Russian.