scholarly journals Capabilities of gravitational surgery for improvement of treatment results in patients with diabetic foot syndrome

2018 ◽  
Vol 99 (3) ◽  
pp. 385-391
Author(s):  
M B Akhmedov ◽  
N S Abushov ◽  
E Dz Zakirdzaev ◽  
Dz V Kosaev ◽  
N I Babaev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lipoic Acid ◽  
Diabetic Foot ◽  
Perioperative Period ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Study Group ◽  
Treatment Results ◽  
Narcotic Analgesics ◽  
Results Of Treatment

Aim. Improvement of complex treatment results in patients with diabetic foot syndrome by introducing methods of gravitational surgery and α-lipoic acid. Methods. The results of treatment were analyzed for 558 patients with diabetic foot syndrome treated in Scientific Centre of Surgery named after M.A. Topchubashov (Baku, Azerbaijan) from 1988 to 2015. The age varied from 28 to 83 years. The patients included 416 men and 142 women. The control group included 90 patients who at the perioperative period underwent basic therapy including antibiotics, anticoagulants, antiaggregants, dextrans, angioprotectors, spasmolytics, corticosteroids, narcotic and non-narcotic analgesics. The study group included 468 patients, along with traditional therapy receiving efferent methods (plasmapheresis, ultraviolet blood irradiation, ozone therapy) and α-lipoic acid. 282 patients of the study group received outpatient treatment and 186 - complex inpatient surgical treatment. A comparative evaluation of the results was performed separately in three groups: angiopathy, neuropathy, angioneuropathy. The results were evaluated by clinical and instrumental examinations before and after treatment (6, 12, 60 months and more). Results. In the study group a satisfactory result of treatment was registered in 85.5% of patients, in the control group - in 62.2%, unsatisfactory in 14.5 and 37.8% of patients, respectively (p=0.046). Conclusion. The use of efferent methods and α-lipoic acid provided prompt elimination of numerous pathogenetic disorders observed in diabetes mellitus, decrease of amputation frequency and improvement of complex surgical treatment results in patients with diabetic foot syndrome.

scholarly journals Result of using a minimally invasive method of surgical treatment of purulent-necrotic complications in a patient with diabetic foot syndrome

2020 ◽  
Vol 39 (3) ◽  
pp. 60-64
Author(s):  
Sergey Y. Ivanusa ◽  
Boris V. Risman ◽  
Andrey V. Yanishevskiy
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Diabetic Foot ◽  
Pain Syndrome ◽  
Diabetic Foot Syndrome ◽  
Military Medical Academy ◽  
Results Of Treatment ◽  
Medical Academy ◽  
Invasive Method ◽  
Short Time

The article presents an analysis of the results of treatment of a patient with purulent-necrotic complications of diabetic foot syndrome, who, in the framework of surgical treatment, used a minimally invasive method of treatment of purulent-necrotic complications of diabetic foot syndrome, developed at the departments of general surgery and normal anatomy of the S.M. Kirov Military Medical Academy. The effectiveness of the developed method has been demonstrated, which makes it possible to sanitize the purulent cavity in a short time, stop pain syndrome and restore the support ability of the foot (4 figs, 1 table, bibliography: 7 refs).

Treating diabetic foot syndrome at the General Surgery Clinic of the S.M. Kirov Military Medical Academy

2021 ◽  
Vol 2 (3(5)) ◽  
pp. 20-29
Author(s):  
S.Ya. Ivanusa ◽  
◽  
B.V. Risman ◽  
A.V. Yanishevsky ◽  
R.E. Shayakhmetov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Diagnostic Algorithm ◽  
Ultrasonic Cavitation ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Physical Methods ◽  
Purulent Wounds

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

scholarly journals Bubbling Treatment Option in the Complex Therapy of Diabetic Foot Syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. 210-215
Author(s):  
Anton Petrovich Ostroushko ◽  
Alexander Alekseevich Andreev ◽  
Alexander Alexandrovich Shmarin ◽  
Vladislav Valeryevich Novomlinsky ◽  
Anastasia Yurievna Laptiyova ◽  
...  
Keyword(s):  
Treatment Option ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Treatment Method ◽  
Late Complications ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Results Of Treatment ◽  
Patients With Diabetes ◽  
After Cancer

Diabetes mellitus (DM) is the most common and socially significant endocrine disease that leads to early disability and is the most common cause of mortality in patients after cancer and cardiovascular pathology. The cost of managing patients with diabetes can reach 30% of the country's health budget, 90% of which is spent on the treatment of its complications. Diabetic foot syndrome (DFS) is developed in 20-80% of patients and is one of the most dangerous late complications. In clinical practice, various approaches to its treatment are used, but the number of high amputation and mortality rate in this group of patients remains significant. The aim of the study was to improve the results of treatment of patients with diabetic foot syndrome (DFS) by including the bubbling treatment method in the program of therapeutic measures. Forty-eight patients with neuropathic and neuroischemic forms of DFS were treated. The control group consisted of 23 patients receiving conventional treatment, the main group included 26 patients, who were applied bubbling treatment option locally. The analysis of groups of patients showed no significant differences by gender, age, stages of diabetic foot syndrome, depth of necrotic defect, complications and concomitant diseases. The use of the bubbling treatment method in the complex treatment of patients with DFS allowed more effectively arresting symptoms of local (edema, hyperemia, wound exudate, necrolysis) and general inflammation, anemia and intoxication syndromes, contributed to the activation of regeneration processes in soft tissues, which, combined with complex FDS treatment, together, reduced the number of amputations by 18.7%.

scholarly journals Comparison of methods of automatic bipolar sealing and monopolar coagulation in the surgical treatment of hemorrhoids in patients with diabetes

2021 ◽  
pp. 47-52
Author(s):  
О. V. Ivanko ◽  
S. V. Skiba ◽  
Hassan Al-Lami Saad Humud ◽  
A. V. Goman ◽  
V. V. Lysytsia
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Daily Activity ◽  
Control Group ◽  
Study Group ◽  
Narcotic Analgesics ◽  
Traditional Methods ◽  
Normal Daily Activity ◽  
Patients With Diabetes ◽  
Surgery Duration

Comparison of LigaSure and traditional methods of surgical treatment of III and IV degree hemorrhoids in patients with diabetes mellitusHemorrhoids are submucosal nodules in the anal canal that contain venules, arterioles, and smooth muscle fibers. Hemorrhoidal disease is registered in approximately 5 % of the total population, especially after 40 years. Treatment is indicated only in symptomatic cases. These symptoms include pain, itching, bleeding, thrombosis and hemorrhoidal prolapse.Aim — to compare the clinical results of he­­mor­rhoidectomy using the electrocoagulation he­mostatic device LigaSure and the traditional Milligan—Morgan method in patients with diabetes mellitus. Materials and methods. The study included 65 patients of both genders aged 18—78 years with stage 3 and 4 hemorrhoids, who underwent hemor­rhoidec­tomy: from them, 33 subject were operated with LigaSure (the main group), and 32 patients with traditional Milligan—Morgan method (control group). The following patients’ data were analyzedretrospec­tively:gender, age, pre- and postoperative hemoglobin and hematocritlevels, surgery duration, the presence of thrombosis, the number of removed and residual hemorrhoids, hospitalization duration, early and late postoperative complications, the need for narcotic analgesics, the observationalperiod, and the time to return to normal daily activity. Results. The mean surgery duration was 16 (6—45) min in the study group and 21 (7—43) min in the control group. Narcotic analgesics in the postoperative period were used in 17 (53.1 %) patients in the control group and were not used in the study group. The timerequired for return to the normal daily activity was 6 (2—15) days in the study group and 8 (2—30) days in the control group. Conclusions. It has been shown that LigaSure gave betterresults of hemorrhoidectomy versus traditional methods in patients with diabetes mellitus in terms of surgery duration, hospitalizationperiod, postoperative pain relief needs, risk of postoperative bleeding, and time required to return to normal daily activity.

CYTOLOGICAL STUDY OF THE DYNAMICS OF THE WOUND PROCESS IN PURULENT LESIONS OF THE DIABETIC FOOT SYNDROME WITH THE USE OF PROGRAMMABLE REHABILITATION TECHNOLOGIES

2021 ◽  
Vol 17 (37) ◽  
pp. 212-227
Author(s):  
Vladimir Anatolievich SERGEEV ◽  
Alexander Anatolyevich GLUKHOV ◽  
Alexander Sergeevich SOROKIN
Keyword(s):  
Diabetic Foot ◽  
Local Treatment ◽  
Diabetic Foot Syndrome ◽  
Limb Amputation ◽  
Control Group ◽  
Critical Ischemia ◽  
Results Of Treatment ◽  
Purulent Wounds ◽  
Cytological Method ◽  
Experimental Group

Background: Purulent lesions of the feet in diabetes mellitus bring excruciating suffering to the patient, reduce the quality of life and often lead to limb amputation and possible death. The disappointing results of the treatment of purulent complications of diabetes encourage the search for both new approaches to treatment and methods for assessing the reparative potential of wound defects. Aim: This study aimed to improve the treatment of purulent-necrotic complications of the diabetic foot by studying the morphological assessment of healing processes when using promising treatment methods such as then programmed debridement. Methods: Over the past 10 years, the results of treatment of 106 patients with purulent-necrotic complications of diabetic foot syndrome (DFS) without critical ischemia have been analyzed. The patients were randomized into two groups. In the experimental group (n = 55), after surgical treatment, the wound was sutured tightly, and in the postoperative period, programmed debridement was carried out using the original AMP-01 device. In the control group of patients (n = 51), the purulent wound was not sutured after the operation, and local treatment was carried out with solutions of iodophors, ointments based on polyethylene glycol. To assess the dynamics of reparative processes in purulent wounds, a cytological method was used, which makes it possible to quickly and reliably assess the stage of the wound process and the effectiveness of the treatment. The simplicity and availability of the method allows it to be recommended to all practicing specialists. Results and Discussion: In the experimental group, by day 9 after surgery, the number of degenerative forms of neutrophils in cytological smears was 2.9 times lower than in the control group - 12.3 ± 0.3% versus 36.4 ± 0.4% (p 0.001) - and the RDI indicator in experimental group was 3.4 times higher compared with the control group - 2.6 ± 0.1 and 0.9 ± 0.1, respectively (p 0.001). This indicated more active phagocytosis, more rapid cleansing of the purulent cavity. An earlier appearance of cells of young connective tissue was observed in the experimental group. The number of fibroblasts by day 9 after surgery was 4.6 times higher (6.4 ± 0.4%) than in the control group - 1.4 ± 0.1% (p 0.001), which confirmed the presence of active regenerative processes in the wound. Conclusions: The use of programmable sanitation technologies in treating purulent complications of a diabetic foot leads to a more significant reduction in the duration of the inflammation phase and acceleration of reparative processes

scholarly journals Comparative evaluation of dermal equivalent effectiveness in neuropathic/and neuroischemic form of diabetic foot syndrome

2016 ◽  
Vol 20 (3) ◽  
pp. 62 ◽  
Author(s):  
A A Kotslova ◽  
M A Binienko ◽  
A N Galileeva ◽  
N M Yudintseva ◽  
S D Sheyanov ◽  
...  
Keyword(s):  
Conflict Of Interest ◽  
Diabetic Foot ◽  
Conventional Treatment ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Study Group ◽  
City Hospital ◽  
Control Groups ◽  
Saint Petersburg ◽  
Dermal Equivalent

<p><strong>Aim.</strong> It was to evaluate the effectiveness of dermal equivalent application when treating ulcers in patients with neuropathic and neuroischemic forms of diabetic foot syndrome (DFS), as well as to compare it with conventional treatment. <br /><strong>Methods.</strong> The study included 60 patients with DFS neuropathic and neuroischemic forms who were treated at Purulent Surgery Departments of War Veterans Hospital and City Hospital No. 14 (Saint Petersburg, Russia) in 2013–2016 years. The patients were divided in two subgroups comparable in age and sex: subgroup A included patients with DFS neuropatic form, subgroup B – those with DFS neuroischemic form. Thus, the study group of patients was formed, who, in addition to conventional treatment of diabetic ulcers, received dermal equivalent application. To assess the effectiveness of dermal equivalent use, two control groups: 10 patients with a neuropathic form and 10 patients with a neuroischemic form of DFS were formed and routinely managed. <br /><strong>Results.</strong> 33 patients (82.5%) (18 patients from subgroup A and 15 patients from subgroup B) out of 40 patients of the study group demonstrated a significantly higher rate of epithelization (p&lt;0.05) as compared to the corresponding subgroup in the control group. <br /><strong>Conclusion.</strong> The efficacy of dermal equivalent is higher when treating a neuropathic form of DFS. The speed of epithelization after the use of dermal equivalent in patients with a neuropathic form of DFS is higher in comparison with a neuroischemic form of DFS.</p><p>Received 5 August 2016. Accepted 23 September 2016.</p><p><strong>Funding:</strong> The study has not been sponsored or awarded a grant.<br /><strong>Conflict of interest:</strong> The authors declare no conflict interests.</p>

scholarly journals The effect of A-PRP-therapy on reparative regeneration of bone tissue with acute bone fractures of the limbs

2019 ◽  
pp. 32-38
Author(s):  
A. N. Blazhenko ◽  
I. A. Rodin ◽  
O. N. Ponkina ◽  
M. L. Mukhanov ◽  
A. S. Samoilova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bone Fractures ◽  
Platelet Rich Plasma ◽  
Control Group ◽  
Study Group ◽  
Reparative Osteogenesis ◽  
Results Of Treatment ◽  
Regeneration Of Bone Tissue ◽  
Fracture Consolidation ◽  
Regeneration Of Bone

Material and methods The study consisted of two parts – in the first part we studied the effect of A-PRP-therapy on the model of a comminuted fracture created in the operating room, an experimental study conducted on 40 Mature rabbits of the Flander breed, all animals were divided according to the principle of analogues into 2 groups (20 animals): in the study group – on the 5th day after osteotomy, platelet-rich plasma was injected into the fracture area, in the comparison group – the fusion occurred without the influence of any drugs. The second part presents the results of clinical testing of A-PRP-therapy, analyzed the results of treatment of 16 women with low-energy fractures of the distal radius metaepiphysis. The study group consisted of 6 patients whose surgical treatment was supplemented by A-PRP-therapy on 7, 14 days after surgery. The control group consisted of 10 patients who underwent surgical treatment without A-PRPtherapy.Results: The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5±1.1%.Conclusion Platelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective procedure. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the Use of a-PRP-therapy to stimulate the maturation of bone calluses. Results The use of platelet-rich plasma to stimulate reparative osteogenesis in accute fractures reduces the time of fracture consolidation by 9.5±1.1%.Conclusion Platelet-rich plasma (PRP) to stimulate reparative osteogenesis is an inexpensive, easy to perform and effective alternative to the methods considered. The possibilities of application of this technology in traumatology and orthopedics require further research in order to create protocols for the use of PRPtherapy to stimulate the maturation of bone calluses. 

scholarly journals Differentiated approach to radical surgical treatment of elderly patients with tumor diseases of the pancreatoduodenal zone

2021 ◽  
Vol 13 (2) ◽  
pp. 49-56
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Alexey V. Gulyaev ◽  
Malkhaz Yu. Tsikoridze ◽  
Evgeny A. Zakharov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Comparison Group ◽  
Main Group ◽  
Control Group ◽  
Study Group ◽  
Tumor Diseases ◽  
Results Of Treatment ◽  
Repeated Surgery ◽  
Pancreatic Fistulas

BACKGROUND: In recent years, there has been a widespread increase in the incidence of tumors of the pancreatoduodenal zone, especially noticeable in the older age group. A decrease in the incidence of postoperative complications and mortality after pancreatoduodenal resection made it possible to expand the indications for surgical treatment of elderly and senile patients. AIM: Improvement of the immediate results of pancreatoduodenal resection in the treatment of elderly and senile patients suffering from tumor diseases of the pancreatoduodenal zone. MATERIALS AND METHODS: Pancreatoduodenal resection was performed in 61 elderly and senile patients with tumors of the pancreatoduodenal zone. The main group consisted of 32 patients, whose treatment was carried out in accordance with the developed algorithm for choosing a method for forming a pancreatodigestive anastomosis based on a scale for assessing the risk of developing pancreatic fistulas. The comparison group consisted of 29 patients in whom the method of forming a pancreatodigestive anastomosis was carried out in accordance with the preferences of the operator without taking into account the risk of developing a pancreatic fistula. RESULTS: In the main group, compared with the control group, pylorus-saving interventions were performed significantly more often 27 (84.4%) and 14 (48.3%) (p 0.01). There was also a decrease in the frequency of performing pancreaticojejunostomy 16 (50%) and 22 (75.9%) (p 0.05), due to the use of reservoir terminolateral pancreatojejunostomy 8 (25%) and 0, respectively (p 0.01). Postoperative complications were observed in 14 (43.8%) of the study group and in 21 (72.4%) patients of the comparison group (p 0.05). There was also a decrease in the incidence of postoperative pancreatic fistulas from 8 (27.6%) to 2 (6.2%) (p 0.05) in the study group. Repeated surgery was required in 5 (15.6%) patients of the main group and 11 (37.9%) in the comparison group (p 0.05). The lethal outcome was recorded in 3 (9.4%) patients of the main group and in 7 (24.1%) in the comparison group (p 0.05). CONCLUSIONS: The results of performing pancreatoduodenal resection in the treatment of elderly and senile patients can be comparable with the results of treatment of the general population. The use of the developed algorithm made it possible to reliably reduce the incidence of complications from 72.4 to 43.8% (p 0.05), postoperative pancreatic fistulas from 27.6 to 6.2% (p 0.05), as well as the frequency of repeated interventions. from 37.9 to 15.6 % (p 0.05). In addition, a downward trend in mortality was achieved from 24.1% to 9.4%.

scholarly journals Plastic coverage of the ulcer-necrotic affections of the foot soft tissues in patients, suffering an ischemic form of diabetic foot syndrome

2018 ◽  
Vol 85 (6) ◽  
pp. 40-43
Author(s):  
S. M. Didenko
Keyword(s):  
Diabetic Foot ◽  
Soft Tissues ◽  
Standard Treatment ◽  
Complete Healing ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Standard Methods ◽  
Results Of Treatment ◽  
Methods Of Treatment

Objective. To improve the results of treatment of the ulcer-necrotic affections of the foot soft tissues in patients, suffering an ischemic form of diabetic foot syndrome (DFS). Маterials and methods. The investigated group have consisted of 48 patients, to whom necrectomy was performed, because a tendency for the wounds healing under the influence of standard methods of treatment through two weeks was absent. Results. After application of the tactics elaborated a complete healing of the wounds was registered in 89.6%, and a partial one - in 10.4% patients. Of 38 patients of a control group, to whom a standard treatment was conducted, the wounds have healed completely in 11 (28.9%), and partially - in 12 (31.6%) patients. Conclusion. Plastic coverage of the foot wounds after necrectomy and early performed revascularization operation for the ischemic form of DFS is indicated to patients, in whom the wounds are lacking a tendency towards healing under the influence of standard methods of treatment through two weeks.

scholarly journals Effect of negative pressure therapy on repair of soft tissues of the lower extremities in patients with neuropathic and neuroischaemic forms of diabetic foot syndrome

2014 ◽  
Vol 17 (3) ◽  
pp. 113-121
Author(s):  
Ekaterina Leonidovna Zaytseva ◽  
Ludmila Petrovna Doronina ◽  
Roman Vakhtangovich Molchkov ◽  
Iya Alexandrovna Voronkova ◽  
Valeriy Afanasievich Mitish ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Standard Therapy ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Perioperative Period ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Negative Pressure Therapy ◽  
Pressure Therapy

Aim. To evaluate the efficiency of topical negative pressure wound therapy (NPWT) compared with standard therapy for the regeneration of the soft tissues of the lower extremities in patients with diabetic foot syndrome. Materials and Methods. The effects of negative pressure therapy on the clinical (size, tissue oxygenation), histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) aspects of repair of the soft tissue of the lower extremities in patients with diabetes mellitus were compared with those of standard treatment. Thirty-one patients with diabetic foot ulcers were included in the study from the moment of debridement until the plastic closure of the wound. During the perioperative period, 13 patients received NPWT (-90 to -120 mmHg) and 18 patients received standard therapy. Results. A reduction of the wound area (26.6%?17.2%) and the depth of the defects (40.5%?25.6%) were achieved with negative pressure therapy compared with baseline data. In the control group, the corresponding values were 25.3%?19.4% and 21.8%?21.6%, respectively. The results of transcutaneous oximetry showed a greater increase in the level of local hemodynamics in the study group (p

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