The Stages of Complex Treatment of Patients with Pyonecrotic Forms of Diabetic Foot Syndrome

Abstract


Relevance The basis for treatment of patients with diabetic foot syndrome (DFS) is currently the staged surgical treatment in combination with conservative therapy aimed at the leading links of pathogenesis of the disease. The purpose of the study To develop and test a treatment algorithm for patients with ischemic and neuroischemic forms of capable supporting foot stump using both direct revascularization (endovascular and open) and indirect revascularization (ROT) methods. Materials and methods The long-term results (two years) in 132 patients with pyonecrotic forms of DFS developed on the background of diabetes mellitus type 2 have been studied. The surveyed patients were divided into three groups in accordance with the methods used to treat them. The first group consisted of 47 patients who received comprehensive medication. The second group consisted of 35 patients to whom in addition to surgical treatment of the affected foot and complex drug therapy to restore blood flow of the lower limb the percutaneous transluminal balloon angioplasty has been performed. In the third group consisting of 50 patients the debridement and complex drug treatment has been completed by revascularization osteotrepanation of the tibia (ROT). Results and their discussion The results of treatment were assessed according to the number of performed high lower limb amputations and mortality within two years. Found that patients with pyonecrotic forms DFS a comprehensive approach requires based on the selection of consecutive stages: the first stage - the solution of the question about emergency limb amputation or surgical treatment of purulent complications, the second stage - the choice of revascularization method based on ultrasonography and angiography. In the case of impossibility of direct reconstructive operations performance on vessels a study of acid base balance of venous blood, in particular, the determination of the partial pressure of oxygen and blood lactate level for the selection of patients to ROT, and the third stage – the performance of necrectomy in the required volume, resection operations on the foot with the formation of functional supporting ability foot stump has been conducted. Conclusion The received findings suggest that the efficacy of treatment of pyonecrotic forms of DFS is based on identifying groups of patients with the conduction of subsequent staged treatment. ROT should be included in the treatment algorithm for patients suffering DFS at impossibility of vascular reconstructive surgeries depending on the parameter of oxygen partial pressure and blood lactate.

Vitebsk State Medical University, 27 Frunze Ave., Vitebsk, 210023, Republic of Belarus

Author for correspondence.
Email: author@vestnik-surgery.com
Assistant Professor of the Department of Hospital Surgery with Courses in Urology and Pediatric Surgery of Vitebsk State Order of Peoples’ Friendship Medical University

  • Bazlov S.B., Porodenko E.E. Evropejskoe Lechenie gnojno-nekroticheskih
  • oslozhnenij sindroma diabeticheskoj stopy na fone kriticheskoj ishemii
  • konechnosti. [EvropTreatment of pyo-necrotic
  • complications of diabetic foot on the background of critical
  • limb ischemia.]
  • Khirurgiia, Vostochnaiaa. 2012; 3:
  • –195.
  • Bel'kov Iu.A., Kyshtymov S.A., Dudnik A.V., Bogdanova
  • M.G. Effektivnost' revaskulyarizacii osteotrepanacii
  • v kompleksnom lechenii bol'nyh s hronicheskoj kriticheskoj ishemiej konechnosti.[Effectiveness of revascularization osteotrepanation
  • in complex treatment of patients with chronic critical limb
  • ischemia. Sibirskii meditsinskii zhurnal.] 2000; 3: 28-32.
  • Bel'kov Iu.A., Kyshtymov S.A., Bogdanova M.G., Dudnik
  • AV. Revaskulyarizaciya osteotrepanacii v slozhnom hirurgicheskom
  • lechenii kriticheskoj ishemii nizhnih konechnostej. [Revascularization osteotrepanation in complex surgical
  • treatment of critical limb ischemia.]
  • Khirurgiia. 2004; 9:
  • –24.
  • Eroshkin S.N., Sachek M.G. Vozmozhnost' primeneniya
  • kislotno-shchelochnogo sostoyaniya venoznoj krovi nizhnih konechnostej
  • dlya prognozirovaniya effektivnosti revaskulyarizacii
  • osteotrepanacii u bol'nyh s sindromom diabeticheskoj stopy [The possibility of application
  • of acid-base status of the lower extremity venous blood
  • for predicting the effectiveness of revascularization
  • osteotrepanation in patients with diabetic foot syndrome.]
  • Vestnik eksperimental'noi i klinicheskoi khirurgii. 2013; VI:
  • : 292–298. - (in Russ.).
  • Ignatovich I.N., Kondratenko G.G., Mikhailova N.M.,
  • Kornievich S.N. Novyj podhod k lecheniyu bol'nyh
  • s nekrotiziruyushchim porazheniem nog, vyzvannyh kriticheskoj ishemiej konechnosti
  • pri sindrome diabeticheskoj stopy. [A new approach to the treatment of patients
  • with necrotizing lesions of the feet caused by critical limb
  • ischemia in diabetic foot syndrome.]
  • Meditsinskii zhurnal.
  • ; 2: 58–64.
  • Ignatovich I.N., Kondratenko G.G., Leonovich S.I.
  • Osobennosti porazheniya arterij u bol'nyh s kriticheskoj
  • ishemiej na fone sindroma diabeticheskoj stopy.[The
  • peculiarities of arterial lesions in patients with critical
  • ischemia on the background of diabetic foot syndrome.]
  • Angiologiia i sosudistaia khirurgiia. 2012; 18: 2: 15-19.
  • Ilizarov G., Zusmanovich FN. Sposob lecheniia
  • khronicheskoi ishemii nizhnikh konechnostei [A method of
  • chronic limb ischemia treatment]. Avtorskoe svidetel'stvo
  • SSSR № 1061803. 1983.
  • Udovichenko OV, Grekova NM. Diabeticheskaia stopa.
  • Rukovodstvo dlia vrachei [Diabetic foot. Guidance for
  • physicians]. Moscow: Prakticheskaia Meditsina, 2010; 273.
  • - (in Russ.).
  • Cherviakov Iu.V. Terapevticheskij angiogenez v lechenii
  • pacientov s hronicheskimi obliteriruyushchimi zabolevaniyami arterij nizhnih konechnostej. Kratkosrochnye i dolgosrochnye rezul'taty.[Therapeutic angiogenesis in the treatment
  • of patients with chronic obliterating diseases of lower limb
  • arteries. The short- and long-term results.]
  • Angiologiia i
  • sosudistaia khirurgiia. 2012; 18: 3: 19-22.
  • Eroshkin SN. Effektivnost' revaskulyarizacii osteotrepanacii pri lechenii gnojno-nekroticheskih form
  • sindroma diabeticheskoj stopy v zavisimosti ot soderzhanie kisloroda v krovi nizhnej konechnosti.Sovremennyj aspekt dlya profilaktiki,
  • lecheniya i reabilitacii.Mezhdunarodnyj Kongress 4-5 iyunya 2013.[ Effectiveness of revascularising
  • osteotrepanation in treating purulent-necrotic forms of
  • diabetic foot syndrome depending on lower limb blood
  • oxygen content. Moderne Aspekte der Prophylaxe,
  • Behandlung und Rehabilitation. Internationaler Kongress 4-5 juni 2013.]
  • Hannover. 2013; 81-82.
  • Gerassimidis T, Karkos C, Karamanos D, Kamparoudis A.Tekushchee Endovaskulyarnoe upravlenie ishemicheskoj diabeticheskoj
  • stopoj.
  • [Current endovascular management of the ischemic diabetic
  • foot.] Hippokratia. 2008; 12(2): 67–73.
  • Mezhdunarodnyj konsensus diabeticheskoj stopy, 2005. VOZ
  • (Evropa) i MFD (Evropa). Lechenie diabeta i issledovaniya v
  • Evrope: Deklaraciya Sent-Vinsent. [International consensus on the diabetic foot, 2005. WHO
  • (Europe) and IDF (Europe). Diabetes care and research in
  • Europe: the St. Vincent Declaration.]
  • Diabetic Med. 2005;
  • : 360.
  • Ruiter M. et al. Diabet uhudshaet arteriogenez
  • perifericheskogo krovoobrashcheniya: obzor molekulyarnyh mekhanizmov.[Diabetes impairs arteriogenesis in the
  • peripheral circulation: review of molecular mechanisms.]
  • Clinical Sci. 2010; (119): 225–238.

Views

Abstract - 49

Без имени (Russian) - 64

PlumX


Copyright (c) 2014 .

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.