Peculiarities of arterial reconstructions in pyonecrotic lesions of lower limbs

Kuznetsov M.R., Boldin B.V., Rodionov S.V., Kosykh I.V., Lisenkov O.P.

Chair of Faculty Surgery No 2 of the Therapeutic Department Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia

Presented herein are the results of treating a total of sixty patients suffering from atherosclerosis obliterans of the lower limbs with degree IV chronic ischaemia according to the Fontain-Pokrovsky classification and accompanied by pyonecrotic alterations. The patients were subdivided into two clinically matching groups, each comprising 30 subjects. All patients after two-week conservative preparation underwent various reconstructive surgical operations performed on major arteries of the lower limbs. The local preoperative treatment was of two different types, i. e. consisting of Levomecol ointment used in the control group patients and Metrogyl 1% topical gel applied in the study group patients. Sampled before treatment, inoculations of the wound discharge demonstrated predominantly anaerobic flora in all patients, with the number of bacterial strains having dramatically decreased once Metrogyl gel 1% had been used, whereas application of Levomecol did not significantly influence the structure of the microbial profile. Following surgical treatment we had to perform high amputation of the lower limb in 5 patients of the control group, whereas in the study group patients only one patient required amputation at the foot level. Hence, prior to carrying out reconstructive vascular interventions in patients presenting with pyonecrotic lesions of lower extremities it is preferable to perform debridement of the necrotic foci using topical antibacterial agents, one of which may be Metrogyl 1% gel.

KEY WORDS: peripheral atherosclerosis, chronic arterial insufficiency of lower extremities, critical ischaemia, pyonecrotic lesions of lower limbs, reconstructive arterial operations, topical antibacterial agents (Metrogyl).

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