METHOD FOR SINGLE-STAGE COMBINED RECONSTRUCTION OF VASCULAR AND WOUND COMPONENTS OF ANGIOTROPHIC INVOLVEMENT OF LOWER EXTREMITIES Russian patent published in 2025 - IPC A61B17/00 A61B17/3207 A61L2/14 A61N7/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to a method for single-stage combined reconstruction of vascular and wound components of angiotrophic involvement of lower extremities. At the first stage, an upper one-third of the thigh is approached; a skin incision is made 2-3 cm from the femoral artery along its pulsation, and an incision line is drawn from the middle of the distance between the spina iliaca anterior superior and the pubic articulation in the direction of the medial femoral condyle. Incision is started from the inguinal fold and continued downwards by 10-12 cm, bypassing the lymph nodes laterally to the cribriform fascia. Cutaneous nerves and a greater saphenous vein located medially are taken aside, lymph nodes are ligated, if they are visualized, the pulsation of the femoral artery is detected, a hip fascia is opened above it and enter the paravasal space. Further, a dissector is brought under the artery from the side of the vein; a siliconised vascular holder is grasped; the artery is pulled up by the vascular holder; the artery is mobilized downwards; the superficial and deep femoral arteries are separated 1-2 cm distally from the plaque; the vascular holders are also brought under them. Then the common femoral artery is clamped under the Poupart's ligament. At the second stage, a femoral artery tomy is performed, a lumen of the common femoral artery is opened, having entered the lumen of the artery, it is cut longitudinally in the distal direction, not reaching 5-10 mm to the bifurcation of the common femoral artery, the length of tomy being 2-3 cm, the artery is washed and dried. Third stage involves endarterectomy, the endarterectomy spatula is inserted into the layer between the plaque and the unaffected wall of the artery and the plaque is mobilized along the entire length of the artery incision, continued to the middle of its posterior wall; similarly, the plaque is detached from the other side of the artery incision, in place of detached plaque from artery wall dissector or curved spatula bypass plaque from behind and circularly cut off from intima of common femoral artery, traction of plaque upwards and using spatula finally separated posterior wall of artery from plaque and cutting off proximal and distal part of plaque "disappearing". Further, the artery is closed with a polypropylene suture with a continuous blanket suture. Before tightening the last suture, air is evacuated from the artery by temporarily removing the clamp. After the stage of revascularization, wound closure and application of sterile dressings on the postoperative wound, the following stage of single-stage complex reconstruction is performed – closure of a trophic ulcer or ulcers by performing autodermoplasty with a free flap with perforation of 1:4. Then performing wound release from non-viable tissues and removal of pathological granulations by acute method and using ultrasonic apparatus "Caviton" in combination with solution of Hydroxymethylquinoxaline dioxide, excision of wound edges at 2-3 mm from edge, wound bed is treated with cold plasma flow generated by “ЭХВЧ-20-МТУСИ” apparatus in mode of 10 seconds per 1 cm². Then a skin graft is taken from the hip along the outer surface or the buttocks with a “ДЭ-60” disc electric dermatome to depth of 0.2-0.3 mm; the graft is perforated 1:4; the graft is laid out and adapted on the wound. Donor wound and the wound covered by the graft are treated with a cold plasma flow in mode of 10 seconds per 1 cm². Wounds are treated with chlorhexidine bigluconate antiseptic solution, 20% solution, Voskopran and atraumatic ointment dressing with Levomekol ointment is applied on wounds and covered with aseptic gauze dressings with fixation of plaster or bandage type.

EFFECT: method enables to perform wound closure during one surgical intervention with vascular reconstruction; preserve natural bifurcation; improve the healing of trophic ulcers on the affected extremity; reduce the risk of infectious complications; minimizing the risk of allergic and other immune reactions, reducing the length of postoperative rehabilitation.

1 cl, 4 ex