Department for Foot Pathology and Complex Prosthetic Treatment
The Clinic for Foot Pathologies and Complex Prosthetic Treatment SI “The Institute of Traumatology and Orthopedics, NAMS of Ukraine” Genesis and development
In the first years after WW2, the problems of amputation, prostheses, aid to disabled persons were highly relevant. In every region, there was a hospital for disabled persons with amputation defects of their limbs, and prosthesis workhouses. To manage their activities, a research and development institute of prosthetic treatment headed by associate prof. O.P. Kotov appeared in Kharkiv in 1944. The task of the institute was to organize recovery treatment, prophylactic medical examinations, prosthetic treatment for disabled persons with stumps of extremities.
The history of the department started in 1945. Then, a hospital resort for partisans in Kyiv was dissolved, and its premises at Institutska street passed to the Orthopedic Institute of Kyiv. More hospital beds made it possible to create a range of new clinics and departments. Among them, there was a prosthetic treatment clinic of 75 beds.
In 1952, the institute moved to the mansion of duke R. Shteingel on 27 Vorovskyi street. The premises were not intended for a surgical clinic and needed reconstruction, so the number of beds was reduced. Namely, only 20 of them remained for the clinic of prosthetic treatment. However, due to the increasing demand for recovery treatment for the disabled, a recovery therapy department and complex prosthetic treatment appeared instead of the prosthetic clinic in 1957.
A.F. Brodsky was the first who headed the department. Andrii Faustovych started studying the creation of appropriately enduring limb stumps. He had developed a method to join the distal end of shin bones with an autoplastic. This principle had become the background for many of that time’s modifications of bone plastic amputations and re-amputations allowing not to shorten a stump’s bony framework.
In 1959, the department was headed by O.D. Lytvynenko, who paid a lot of attention to the treatment of soft tissues lesions and the matters of skin plastics. Jointly with A.F. Brodskyi, he elaborated a method to create a weight-bearing shin stump. Later, Oleksii Danylovych moved to the position of assistant at the traumatology and orthopedic department of the advanced medical education institute.
A. F. Brodskyi
I.G. Antoniuk, A.A. Kurylo, V.M. Levenets, L.G. Plotnik, P.I. Chabanu, O.Y. Romanenko used to work at this department.
Since 1959, having graduated clinical residency, M.I. Khokhol had been enrolled as the department’s scientific researcher. In 1966, she represented his candidate’s research «The Impact of Some Physical Factors on Lower Limbs’ Amputation Stumps Formation». She had experimentally grounded the efficiency of early and consistent physical therapy methods to avoid post-surgical complications. Margaryta Ivanivna proceeded with the rehabilitation to the disabled in her doctor’s thesis «A Musculoskeletal System’s Compensatory and Adaptive Changes and Rehabilitation after Amputations of Thigh and Shin», represented in 1986.
Since 1967, the department was headed by prof. O.O. Bukhtiarov (1925-1993), one of the prominent persons who organized orthopedic-and-prosthetic aid. At that time, the department’s work was focused on the improvement of the support to the disabled with stumps of limbs, as well and orthopedic and prosthetic aid.
Scientific researches were mostly devoted to bone plastic reconstructive surgery to stumps.
Members of the department had offered 12 methods of bone-plastic amputations and re-amputations on different levels of a shin, a method to fix a patella within Gritti-Shymanovskyi operation. By them developed supportive elements of lower limbs prostheses are still in routine fabrication, rational offers are applied for prosthesis units and means.
Alongside the aid of the disabled, the department had collected the experience in lower limb amputations in patients with terminal stages of obliterating angiopathy, which appeared from time to time for treatment.
Doctor Biletskyi M.Y., a student of Prof. O.O. Bukhtiarov and recognized expert in reconstructive surgery of stumps and prosthetic treatment, used to work at the department from 1968 till 2016. For many years, Mykola Yosypovych has been sharing his vast experience with the institute’s young physicians, managing the interaction between the hospital and the Kyiv prosthesis plant.
Since 1991, the department was headed by Doc.med.sc. O.E. Mikhnevych (the laureate of the USSR State Award), the known expert in congenital hand development disorders. With his scientific research, he elaborated new methods for limbs’ amputations and re-amputations, improved the post-surgical surveillance of amputation patients, developed devices and means to treat phantom pain syndrome, and offered and approved new types of therapeutic training prostheses. The clinic created a prosthesis workshop to discharge patients after limbs’ amputations and re-amputations with tailored therapeutical and training prostheses. In 1992, that time closed laboratory of biomechanics joined the department. It has been recovered thanks to O.E. Mikhnevych’s sustained efforts.
1992 was the lynchpin year for the view on lower limbs’ deep trophic disorders. Then, Oleh Eduardovych had successfully applied a subcutaneous fasciotomy on a shin of patients with a diabetic foot in neuropathic form. O.E. Mikhnevych had disclosed that subfascial pressure in the foot and shin is high in patients with trophic disorders based on obliterating angiopathy. Clinical and instrumental studies laid in the basement of an interstitial hypertension theory created and theoretically grounded by O.E. Mikhnevych. In 2000, cand.med.sc. A.P. Liabakh, who arrived at the department from a microsurgery clinic, had significantly extended the scope of surgical interventions. The vast collection of clinical material at the department, the interest of Andrii Petrovych in foot surgery matters, re-organization of the department into the one of foot pathology and complex prosthetic treatment had predetermined a new scientific direction, preservation of weight-bearing capacity in patients with deep trophic disorders of lower limbs.
The experience in congenital foot pathologies treatment and scientific ideas by O.E. Mikhnevych encouraged the department’s member H.M. Lazarenko to create her candidate’s thesis “Diagnostic and Treatment of Foot Macrodactylia», represented in 2004. An original concept of pathological foot formation, adequate in age and anthropometric values, the background of the research, had been completely approved in clinical aspect and confirmed with a complex radiological and morphological study. Halyna Mykolayivna keeps working in the department. She is a recognized expert in foot macrodactyly matters within the whole post-Soviet area.
In 2004, prof. A.P. Liabakh represented his doctor’s thesis “Diagnostics and Surgical Treatment of Acquired Foot Deformities” with new perspectives in foot deformities treatment based on improved and new surgical correction methods. It offered methods for pre-surgical planning and intraoperational marks for foot arthrodesis and osteotomies, an original method of V-shaped foot resection, classification of severity, and indications for early amputations in patients with ischemic foot contractures (jointly with S.S. Strafun). Since 2011, prof. A.P. Liabakh heads the department. That time, he became a professor. Alongside his scientific and surgical activities at the department, Andrii Petrovych founds time for sanitary aviation work and public activities. He is a member of SICOT, heads Kyiv unit of the “Ukrainian Association of Orthopedists-Traumatologists”, a scientific editor at the journal “The Herald of Traumatology, Orthopedics, and Prosthesing», a member of the advisory council at the Ukrainian Peace Council. He is the author of over 400 publications, methodic recommendations, manuals, and books. He has Orders «For the Aid in Protection of the State Board of Ukraine», «of Labor Glory», II level, Order of Peace, II level.
Andrii Petrovych supervises the scientific theses by Pipia G.G. (2007), Artemenko V.O. (2007), Yakimov D.Y. (2007), Nanynets V.Y. (2013), Piatkovskyi V.M. (2015), Khimich O.M. (2016), Kuleva O.V. (2017)
Within 2003 – 2004, having graduated their clinical internship, the youth had arrived at the department: Turchyn O.A., Mikhnevych (Artemenko) V.O., Pomishchyk D.L. They started their constrained study to choose a scientific way. Mikhnevych (Artemenko) V.O. proceeded with studying the mechanism of subcutaneous fasciotomy impact on trophic of a lower limb and discovered the dynamics in changes of mitochondrial enzymes (CFC and LDG) and neurotrophic processes (AXE) in a lower limb’s skeletal muscles in patients with deep trophic disorders after the fasciotomy. For the first time, a relation had been discovered between a segmental systolic pressure, internal bone, and subfascial pressure in this category of patients to demonstrate the positive effect of subcutaneous fasciotomy on regional hemodynamics.
These data have been represented in the candidate’s thesis “Preserving the Weight-bearing Capacity in Patients with Lower Limbs’ Deep Trophic Disorders”, represented in 2007.
The use of the subcutaneous fasciotomy for not-specific influence on a lower limb’s trophic has optimized the outcomes after foot bone-infection complications in patients with diabetes mellitus. First of all, this decreased the share of lower limbs amputations, especially above the knee. This aspect of the critical medico-social problem has been expressed in the candidate’s thesis by S.A. Sapa “Surgical Treatment of Patients with Diabetic Foot Syndrome, complicated with an Infectious-Necrotic Process”, represented in 2006.
Within 2005 – 2007, D.Y. Yakimov had been working over his candidate’s thesis “Orthopedic Prevention and Treatment of a Diabetic Foot Complications” with further elaboration of the matter of biomechanical changes as an essential factor of trophic disorders progression in diabetes mellitus patients. For the first time, he considered elasticity features of the weight-bearing surface of a foot and demonstrated direct dependence between the worsening of a foot’s trophic and increase of the elasticity modulus in diabetes mellitus and obliterating atherosclerosis patients. On the background of studying the support reactions, he substantiated the expediency of individual orthopedic insoles for diabetic foot patients.
D. Y. Yakimov
The wide scope of the department’s surgical activities has predetermined the success of the candidate’s thesis by Pipia G.G., represented in 2007 – “Optimization of a Therapeutic-Diagnostic Process in Polytrauma Patients with Pelvic Injuries”, supervised by Liabakh A.P. Having scientifically analyzed a large massive of polytrauma victims, he was the first to ground a preventive pelvic ring stabilization concept. This clinical-organizational pattern decreased mortality by 11.9%, the share of complications – by 10.2%, and improved the long-term results. Today, Gocha Guramovych works at the polytrauma department of Kyiv city emergency hospital.
In 2009, an oncologist-orthopedist Protsenko Volodymyr Viktorovych has moved to the department from the National Cancer Institute, having won a competition. Here, he proceeded with the problem of patients with initial and metastatic bone tumors. In 2010, Protsenko V.V. had represented his doctor’s thesis “New Approaches to Myeloid Sarcoma Treatment”.
Volodymyr Viktorovych is a member of ESMO (European society for medical oncology, 2013), EESG (East-European Sarcoma Group, 2013), valid member of the European Academy of Natural Sciences (2014). He is the author of over 220 publications, 12 patents of Ukraine, and 4 monographs.
V. V. Protsenko
He also carries on scientific and pedagogic activities at institutions of higher education. 4 candidate’s theses were represented under his supervision: Mensia Kasem (2014), Zhylchuk A.V. (2016), Solonitsyn E.O. (2017), Tuz E.V. (2018). Protsenko V.V. has elaborated and patented means and methods to treat musculoskeletal tumors: bone plastic surgery using implants based on HA, TCP, and biocomposite for bone tumors, less-invasive surgery methods (extrafocal osteosynthesis with external fixation devices) for metastatic lesions to long tubular bones, and complex methods for patients with malignant neoplasms and metastatic skeleton lesions, including surgical, chemotherapeutical, radiation methods, the use of bisphosphonates, hormone therapy, and immune therapy.
In 2018, Protsenko Volodymyr Viktorovych got the title of professor and the honorary degree of Emeritus Doctor of Ukraine. He has an Order «For the Aid in Protection of the State Board of Ukraine»
A. V. Zhylchuk, E. O. Solonitsyn, E. V. Tuz
The department is doubtlessly a leader in the orthopedic treatment of inherited neuropathies. The candidate’s dissertation by O.A. Turchyn “Surgical Correction of Foot Deformities in Patients with Inherited Motor-sensor Neuropathy”, represented in 2010, has harmonically jointed further development of theoretical biomechanical studies, started by the department, with the improvement of original surgical methods. Namely, for the first time, it determines the role of an anterior equinus in a pathomechanogenesis of a hollow foot, demonstrating the essence of symmetric hollow foot in the genesis of lateral instability in patients with inherited motor-sensor neuropathy, traditionally connected with ataxia.
The continuation of the scientific topic related to trophic disorders has logically stipulated the presentation of doctor’s thesis by I.S. Savka in 2011 “Diagnostics, Complex Treatment, and Prevention of Injuries to Lower Limb Bones in Soldiers due to Overload”. There, Ihor Stanislavovych proceeded to study the increased subfascial pressure as a reason for overload disease occurrence in soldiers.
In 2013, V.Y. Nanynets (that time – trauma surgeon at Bobrovytsi Central Regional Hospital) represented his Ph.D. research «Diagnostics and Surgical Treatment of Calcaneal Bone Fractures Consequences».
One of this research’s essentials was the determination of factors impacting anatomical-physiological outcomes after calcaneal fractures treatment; for the first time, he demonstrated that the Bohler angle, so popular among trauma surgeons, is not reliable to diagnose the displacement of a calcaneal posterior articulated surface. Nowadays. Vasyl Yaroslavovych works at the department.
V. M. Piatkovskyi
Further studies of a lower limb’s trophic matters, upgrades of surgical techniques, modern means for osteosynthesis allowed an active surgical tactic to treat neurogenic arthropathies. This is especially relevant for diabetes mellitus patients. The strenuous clinical work and cooperation with immunologists (cand.med.sc. Panchenko L.M.) and morphologists (prof. A.T. Brusko) started a new direction in diabetic foot treatment – joint stabilizing surgeries at an acute stage of the arthropathy process.
This titanic work has been summarized in an amazing Ph.D. thesis by V.M. Piatkovskyi “Diagnostic and Treatment of a Diabetic Foot Osteoarthropathy”, represented in 2015.
The long-term experience with lower limb trophic disorders was summarized in a fundamental scientific topic «Prognostication of a Progression and Pathogenic Grounding to Orthopedic Treatment of Lower Limb Trophic Disorders in Patients with Injured Peripheral Nerves», awarded with a commendation by the Presidia of NAMS of Ukraine as the best fundamental scientific research in 2014. The research has demonstrated the uniformity of biochemical and morphologic changes in tissues in peripheral nerves injuries of different etiology, and the presence of regional hemodynamics disorders in polyneuropathies. The essential scientific breakthrough of the research was the determination of a footprint elasticity modulus as an integral sign of trophic disorders with not only diagnostic but also forecasting significance.
The matter of lower limbs amputation in patients with trophic disorders has found its continuation in the elaboration of predictors of knee preservation in high lower limb amputations. It was a topic of the Ph.D. thesis by an extramural Ph.D. candidate O.M. Khimich “Shin Amputations in Patients with Obliterating Angiopathies”, represented in 2016.
For the first time, has it become possible to differentiate the indications to a transtibial amputation in patients with chronic lower limb ischemia based on available values (M. Charlson comorbidity index, hemoglobin level, the value of an ankle-brachial index). Today, Oleksandr Mykolayovych works as an orthopedic surgeon at Zhytomyr 1st City Hospital.
O. M. Khimich
The vast experience in the treatment of lower limb traumas consequences has predetermined the choice of the topic for Ph.D. thesis by Kuleva O.V. “Muscle Transposition in an Achilles Tendon Injury”, represented in 2017. In his research, Oleksandr Valeriiovych has substantiated biochemically and anatomically the use of ligament-muscle transpositions in long-standing and fresh subcutaneous Achilles tendon ruptures. Biochemical and ultrasound studies have provided convincing proof to the theory of a durable degenerative process in an Achilles tendon’s tissues before the rupture. Besides, for the first time, he demonstrated priority in the use of donor muscles from a peroneal muscle group.
Today, the department keeps growing scientifically and practically, continues its fundamental studies started at its establishment. The vast experience in limb amputations served as military actions burst out in Eastern Ukraine. Over 300 participants of military actions got surgical aid directly at the department and military medicine institutions.