The Possibilities of the Application of Venous Blood Acid-Base Balance Indices of the Lower Extremity to Predict the Effectiveness of Revascularizating Osteotrepanation in Patients with Diabetic Foot Syndrome

Relevance Pyonecrotic forms of diabetic foot syndrome (DFS) is the leading cause of lower extremity amputation. The purpose of the study To establish the dependence of the efficiency of the treatment of pyonecrotic forms of diabetic foot syndrome (DFS) by using the tibial osteotrepanation to limb revascularization on the preoperative indices of venous blood acid-base balance (ABB) of the affected extremity. Matherials and methods The studies were performed in 42 patients with pyonecrotic forms of (DFS) (males and females, aged 52– 68 years.) Determination of the partial oxygen pressure (pO2 ), carbon dioxide (pCO2), and lactate concentration in blood taken from the leg veins of the affected limb has been is carried out by the analyzer Radiometer ABL-700 (Denmark). The first group consisted of 15 patients with RvO2 12.6 – 30 mm Hg., the second - 12 persons with RvO2 31,1– 51 mm Hg. and a third group consisted of 15 patients - RvO2 52 – 88 mm Hg. There were no significant differences in age, sex and clinical data in the observed group. Results and their discussion In 12 months after the beginning of the study the patients with low RvO2 level and high lactate concentration the high amputation was performed in 20% of cases, the patients with RvO2 level maximal closed to physiological norm and low lactate level the high amputation was performed in 8.3% of cases and the patients with high RvO2 level in conjunction with elevated lactate level – in 30% of cases. Conclusion The obtained data indicate that the effectiveness of revascularizing osteotrepanation (ROT) is primarily determined by the individual potential of collaterals growth in the lower limb. An indirect factor characterized this process is considered to be the venous blood acid-base balance of the affected limb. The best results of ROT were observed in averages RvO2 (LQ - UQ = 33,4 - 44,2 mm Hg.) in combination with low lactate level (LQ - UQ = 1,25 - 1,66 mmol / l). The worst results was noted in elevated RvO2 (LQ - UQ = 46,8 - 69,9 mm Hg.) in combination with high lactate level (LQ - UQ = 2,01 - 2,49 mol / l). RvO2 and venous blood lactate indices of the affected limb can be used to predict the revascularizating effect of tibial osteotrepanation and the necessity to include this method in the complex treatment of patients with pyonecrotic forms of DFS.

Diabetic foot syndrome, revascularizing osteotrepanation, partial pressure of oxygen, partial pressure of carbon dioxide, high amputation