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

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