Superb microvascular imaging to monitor hemodynamic changes in lower limb arteries in treatment of diabetic foot by tibial transverse transport / 中华创伤骨科杂志

ABSTRACT

Objective:To evaluate superb microvascular imaging used to monitor the hemodynamic changes in lower limb arteries in the treatment of diabetic foot by tibial transverse transport.Methods:From December 2019 to December 2021, 17 patients with diabetic foot were treated by tibial transverse transport at Department of Orthopedics, The Second Hospital of Shanxi Medical University. Superb microvascular imaging was used to observe the vascular index of the first dorsal metatarsal artery, the total blood flow of the anterior tibial artery and the posterior tibial artery, and the Wagner classification in the patients before surgery, one week and one month after surgery. Complications were documented.Results:After treatment, neovascularization was observed in all the 17 patients and detected on both the ipsilateral and contralateral sides of the surgery. At the last follow-up, the number of newborn collaterals was 7.0 (3.5, 9.0), significantly larger than that before surgery [1.0 (0, 1.5)] ( P<0.05). The vascular index of the first dorsal metatarsal artery at one week (9.70±10.88) and one month (9.22±5.46) after surgery was significantly higher than that before surgery (5.65±4.36) ( P<0.05). There was no significant difference in the total blood flow between the anterior tibial artery and the posterior tibial artery before surgery, one week or one month after surgery ( P>0.05). The Wagner classification at one month after surgery (grade 1 in 4, grade 2 in 11 and grade 3 in 2) was significantly better than that before surgery (grade 2 in one, grade 3 in 2 and grade 4 in 14) and one week after surgery (grade 2 in one, grade 3 in 5 and grade 1 in 11) ( P<0.05). One patient underwent amputation due to acute lower extremity arterial embolism 2 months after operation, and another patient underwent toe amputation due to blackening of the toes. Conclusion:Superb microvascular imaging is a valuable means of monitoring in tibial transverse transport because it can objectively reflect the hemodynamic changes and microcirculation in lower limb arteries and provide valuable information for prognosis of the condition in the treatment of diabetic foot by tibial transverse transport.