METHOD OF COMBINED SURGICAL STIMULATION OF LOWER EXTREMITY CHRONIC LOWER LIMB NEOANGIOGENESIS

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to vascular surgery, and can be used for treating patients with chronic, critical ischemia of lower extremities of mainly III and IV degrees, in occlusion diseases of arteries with involvement of distal arterial bed, when the use of direct reconstructive operations on the vessels is impossible, and the pharmacological, physical and biological techniques for stimulating the collateral blood circulation remain ineffective. Method involves trephine opening. Through osteoperforatory holes are made on all extremities, using clamp of "mosquito" type and stupidly passing through all layers of tissue to bone. In the formed holes, a guiding protective tube is inserted into which a drill is installed. On thigh through 10 separate punctures of skin and wide fascia of hip with length of up to 1.0 cm along outer surface accesses to external surface of femur, wherein in projection of proximal epiphysis of femur, from level 5 cm below greater trochanter, through every 4–5 cm in distal direction along external surface exactly in middle of bone through inserted before bone protective tube guide by drill with diameter of 4.5 mm in transverse direction in center performing three through perforations, passing both cortical layers before the sponge substance content is applied from the drill guide and is filled with a red scarlet substance. In the projection of the diaphysis in the transverse direction at the center of the external surface at a distance of up to 4–5 cm from each other, 4 damages are performed by drilling in the external layer of the periosteum without a dip into the intramedullary canal; 3 perforated holes of distal metaepiphysis are made at distance of 4–5 cm from each other in proximal direction, projecting first bone drilling from level of upper edge of patella. On the shin the through perforations of the proximal and distal phalangees of the tibia, 3 per each, are performed monotonously, as on the femur, but the direction of drilling is performed from the inner surface of the shin. 4 damages by drilling in outer layer of periosteum, without a dip into medullary canal, in diaphyseal part on medial surface of shin bone are performed also at distance of up to 4–5 cm from each other, through muscular massif of anterior region of shin. On the foot of one prick on the inner surface of the heel, 1.5 mm Kirshner wire, the heel bone is perforated "in-line", through, without removing the pin from the prick three times in different directions, and on the side of I metatarsal bone, at a distance of up to 3 cm between the injections, transverse through tunneling of I-II-III-IV metatarsal bones is performed twice; through the produced orifices with syringe of 20.0 ml, introducing the autologous autoconcentrate of stem cells with a total volume of 100 ml into the soft tissues and the osteoperforation zones on the thigh, on ankle additionally and in muscular mass of anterior, external and posterior osteo-fibrous sheaths, on foot in I-II-III-IV, intercellular spaces.;EFFECT: method provides expansion of reserve vessels, precapillaries and lumen of surviving vessels, creates prerequisites for stimulation of neoangiogenesis, improving possibility of collateral microcirculatory blood flow due to differentiation of introduced stem cells (SC), leads to activation of tissue perfusion and increased capacity of peripheral vascular bed in ischemic tissues along entire length of involved limb.;1 cl, 3 tbl, 3 ex