Invasive luminescent spectroscopy in determining surgical tactics in lower limb amputation

Introduction. Currently, due to the increase in amputations, it is becoming relevant to reduce its level for better rehabilitation of patients.

Aim. To evaluate the results of the use of invasive photoluminescence spectroscopy to determine the level of limb amputation.

Materials and methods. A prospective, open-ended, non-randomized study involved 24 people with a clinical picture of KINK after endovascular reconstruction. For gangrene of the foot, amputation was performed at the level of the upper third of the lower leg on day 6–7. The patients were monitored during 1 turnout. All patients were divided into 2 groups. Group 1 (n = 10) consisted of patients who had no complications after amputation, group 2 (n = 14) – who had complications from the stump. In all patients, photoluminescence measurements of the affected limb were performed according to our proposed method at thelevel of future amputation. The results of the study were presented in the form of an average value, standard deviation or median and the 25th, 75th percentiles.

Results. The intensity of the glow was higher in the second group of the study, where various complications later developed. When comparing the intensity of photoluminescence with the area of necrotically altered muscle fibers detected by microscopy, a direct relationship between these two indicators is noted. An 11-fold increase in the number of necrotically altered fibers was revealed at luminescence intensity above 10,000 × 105 photons.

Discussion. With an increase in the degree of blood supply, a decrease in the degree of tissue ischemia, a decrease in the luminescence intensity at the nicotinamide dinucleotide peaks and a more intense signal reduction at the hematoporphyrin frequency were observed. These circumstances explain the decrease in the amplitude of the glow as the measuring needle moves from the surface of the skin deeper into the skin and approaches the main arteries.

Conclusions. Luminescent spectroscopy is the method of choice for determining the level of amputation of the lower limb.

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