| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention relates to vascular surgery, and can be used in treatment of occlusive diseases of arteries of lower limbs: obliterating atherosclerosis, obliterating thromboangiitis, diabetic angiopathy of arteries of lower limbs. Mobilisation of greater omentum starts with cutting across short branches of gastroepiploic artery on large curvature of stomach. Then omentum is cut off transverse colon and its mesentery. Precisionally left and right gastroepiploic arteries and veins are. Exposed along not less than 10 mm. Two flaps are cut out of omentum and divided in sharp way into two equal parts. Each flap has blood supply only from one gastroepiploic artery. Then exposed left vascular pedicle, which includes left gastroepiploic artery and vein of greater omentum, is cut across. Autotransplant, which is feeding from said vascular bundle, is moved from abdominal cavity to area of formation of microvascular anastomoses on lower third of thigh.The other part of omentum is left in abdominal cavity. Abdominal cavity is hermetised by applying sutures on wound Replaced omentum flap is laid in region of popliteal space intermuscularly and microanastomosis is formed between gastroepiploic vein and femoral vein in lower third of thigh. Then microanastomosis is formed between gastroepiploic artery and superficial femoral artery. After formation of microanastomoses, final placement of autotransplant on lower limb is performed. Wounds on thigh and shin are covered with wet napkin with antiseptic without suturing. Second transplant is moved from abdominal cavity to place of formation of microvascular anastomoses on lower third of another thigh. Operation is continued by two teams of surgeons. The first lays omentum and forms microvascular anastomoses analogously to contralateral limb. The second team sutures abdominal cavity layer-by-layer. Operation is finished with applying sutures on subcutaneous cellular tissue and skin without suturing fascia on both lower limbs. ^ EFFECT: obtaining possibility to preserve both lower limbs, to stop ischemia at rest and to increase distance that can be walked without pain in patients with distal forms of obliterating arterial involvement. ^ 1 ex |
