Modern methods of treatment of diabetic foot syndrome]

Method of complex treatment of the diabetic foot syndrome (DFS), which included combined application of intravascular laser irradiation of blood, ultraviolet irradiation of blood, indirect electrochemical detoxication of organism, endolymphatic therapy, abacterial environment, modern methods of physical antisepsis was elaborated and introduced in practice.     

Application of tivortin in complex treatment of diabetic foot syndrome

Theoretical pre-conditions and practical possibilities of preparation Tivortin application in a complex of surgical treatment of diabetic foot syndrome were studied up. Basing on the result of the investigation performed it was established, that while this preparation application a postoperative period course improves, the carbohydrates metabolism normalizes, the pain syndrome intensity reduces.     

Revascularization surgery in the treatment of the diabetic foot syndrome

The prospective study includes 142 patients with necrotic ulcers of feet in frames of the neuroiscemic form of the diabetic foot syndrome. 60 patents had revascularization procedures, of them 14 had open vascular operations and 46 had endovascular procedures. The high efficacy of revascularization in the group of patients with neuroiscemic form of the diabetic foot syndrome. The procedure allowed to decrease the rate of critical limb ischemia and high amputations (p=0,037).     

Monitoring of diabetic foot syndrome treatment: some new perspectives

Diabetic foot syndrome (DFS) is one of the major complications of diabetes, and it can lead to foot amputations. It is very important to assure good medical care for diabetic patients not only during their stay at hospital but also at home. Telecare can be one good solution for extending medical care to patients' homes. There are some reports regarding the application of new technologies in this field. The standard current model of telecare of DFS includes experts at hospital who conduct clinical examinations and decision making at a distance, in close cooperation with a visiting nurse and the patient. In the present paper a new paradigm of the DFS's telecare is introduced, which eliminates the visiting nurse. The designed and developed TeleDiaFoS system consists of a traditional database and mobile patient's module (PM) allowing for documentation of the foot images as well as the results of blood glucose and blood pressure measurements taken by the patient himself at home. A 2-year validation of the TeleDiaFoS system on 10 DFS patients (3 months each) proved its usefulness and led to acceptance of this type of technical support by patients and physicians. The designed and developed system and proposed sterilization procedure of the PM have been found to be easy to use by the patient at home.     

Differentiated approach to the surgical treatment of diabetic foot syndrome]

The results of surgical treatment of 334 patients with diabetes mellitus with diabetic foot syndrome (DFS) were analyzed. The surgical intervention performance is based on analysis of pathogenetic form of affection, its depth and extension, type of microflora in the pyo-necrotic focus. We attempted to achieve surgical cleansing or partial foot amputation in every patient in order to preserve the support function of the foot. The use of differentiated approach to surgical treatment of DFS permitted to decrease the rate of high leg amputation from 17 to 7.2%, to decrease the duration of surgical treatment by 11.2 days.     

Clinical classification of diabetic foot syndrome

Basing on analysis of the treatment results in 521 patients, suffering diabetic foot syndrome (DFS), the clinical classification was proposed, taking into account regulations of the International agreement on diabetic foot. It contains pathogenetic mechanisms of DFS occurrence, severity of the nerves and vessels affection, degree of ischemia, character of purulent-necrotic complications. Classification permits to determine the methods of treatment in homogenous groups of patients, suffering DFS.     

Experience of diagnosis and treatment of phlegmon in the diabetic foot syndrome

In the clinic in 2007-2010 yrs 123 patients were treated for diabetic foot syndrome (DFS). In 29 (34.1%) of them the foot phlegmon was diagnosed, including 9 (31%), suffering osteomyelitis of 2-3 metatarsal bones. Neuropathic form of DFS was diagnosed in 20 (69%) and angiopathic one - in 9 (31%) patients. In a day of admittance to hospital 26 (89.7%) patients were operated, in a one day, after conduction of purposeful preoperative preparation - 3 (10.3%). Incomplete sutures were put on, the flow cleansing of wounds, using antiseptic solutions, were used. Wounds were treated in accordance to course of the wound process phases. Besides antibacterial and desintoxication therapy conduction, peripheral vasodilators, hypoxants, and in neuropathic form of DFS the group B vitamins and preparations of alpha-lipoic acid, were prescribed. All the patients have recovered. A stationary treatment term of patients, suffering neuropathic form of DFS, have constituted at average (16.3 +/- 4.2) days, and in angiopathic one - (19.4 +/- 3.6) days. The foot support ability was secured in 96.6% of patients.     

Etiology,pathogenesis, classification and surgical treatment of diabetic foot syndrome

Basic points of ethiology and pathogenesis of diabetic foot syndrome (DFS) are given. Classification of DFS is proposed as regards to clinical forms, stages and localization of the process. Algorithm of treatment of each clinical form of DFS including surgical methods is substantiated. Indications for organo-saving surgeries on the foot, and also for high amputation of the leg are determined clearly. Results of treatment of 484 patients with DFS are analyzed. This algorithm can reduce number of high amputations 2 times. It is noted that early hospitalization of patients with initial stages of the disease, organization of curative process depending on DFS clinical form permits to improve results of FDS treatment.     

Surgical classification of the diabetic foot syndrome

Surgical classification of the diabetic foot syndrome was proposed, permitting to formulate pathogenetic diagnosis with working out in detail the foot pathologic process depth and expansion, taking into account the microflora presence in the purulent-necrotic affection zone, basing on own experience of treatment of 490 patients. This permits to formulate tactic and volume of necessary pathogenetic surgical and conservative treatment.     

Strategies of the diabetic foot treatment

Clinical course and efficacy of treatment of the diabetic foot phlegmon in 47 patients were analyzed. The phlegmon opening was the definitive intervention in 85% of patients, the phlegmon opening with fingers amputation--in 67%, the phlegmon opening and Sharp operation--in 87%. The bearing function of foot was preserved in 73% patients.     

Improvement of results of surgical treatment of patients syndrome of diabetic foot]

Results of complex treatment of 121 patients with syndrome of diabetic foot, complicated by purulent-necrotic affection of tissues, were analyzed. Individually differentiated approach in the choice of surgical tactics had permitted to improve the result of treatment.     

糖尿病足的外科一站式治疗

目的 探讨糖尿病足外科一站式治疗的临床价值.方法 175例(206条肢体)糖尿病足患者,根据患肢的不同情况,灵活组合应用球囊扩张和(或)支架成形术、局部清创术、持续负压引流术、特殊敷料换药、人工血管旁路术、自体静脉旁路术、杂交手术、截肢(趾)术、单纯保守治疗等各种治疗措施.结果 腔内治疗和旁路术治疗的糖尿病足患者术后1...     

Results of surgical treatment of ischemic gangrenous form of the diabetic foot syndrome

Results of surgical treatment of 189 patients with diabetes mellitus with the diabetic foot syndrome, suffering an ischemic gangrenous form, stages II-IV (according to Wagner), were analyzed. The accomplishment of surgical treatment or small amputation of foot and preservation of the extremity supportive function was tried in every patient. Optimization of the patients surgical treatment was elaborated, basing on clinical investigations data, rheovasography and estimation of local blood circulation in tissues according to hydrogen clearance. In 79.2% of observations the satisfactory outcome was achieved with the lower extremity preservation. In 21.8% patients after high amputation of extremity postoperative mortality had constituted 9.8%.     

Surgical treatment of purulent necrotic complications in patients with diabetic foot syndrome]

Results of treatment of 207 patients with purulent-necrotic complications of the diabetic foot syndrome (DFS) were analyzed. Tactics of treatment was determined considering the DFS form presented, stage of the extremity ischemia, character and severity of purulent-inflammatory affection and the patient's homeostasis state. Urgent operation was performed in 79 (38.1%) patients, in 38 (48.1%) of them--amputation of extremity. In late follow-up period 98 (47.3%) patients were operated on, in 76 (75.5%) of them necrectomy or small amputation was performed, allowing to preserve the extremity. Conservative treatment was conducted in 30 (14.5%) patients with trophic ulcers. Application of elaborated program of treatment had permitted to increase the preservation frequency of supporting function of foot from 28.9 to 56.3% and to reduce general lethality from 18.3 to 13.5%.     

糖尿病足溃疡创面的综合治疗

目的：探讨如何促进糖尿病足溃疡创面愈合,降低致残率。方法：对糖尿病足溃疡患者,在积极的内科治疗稳定病情的基础上,采用以创面清创换药,改善局部血运和促进局部组织生长,或采用整形外科手术的方法治疗。结果：52例糖尿病足溃疡创面,除1例因溃疡坏疽创面较深大合并骨髓炎行截肢外,其余均顺利修复。平均随访90．4%,疗效满意率91．5%,出现溃疡复发或有新的皮肤溃疡者8．5%。结论：在全身治疗稳定病情的基础上,积极进行创面处理和整形外科手术的综合治疗是促进糖尿病足溃疡创面早期愈合,缩短病程和降低致残率切实可行的方法。重视糖尿病足患者溃疡愈合出院后的康复指导工作至关重要。     

Peculiarities of surgical treatment of patients with complicated forms of the diabetic foot syndrome

There were analyzed the results of surgical treatment of 246 patients, suffering diabetes mellitus, with destructive forms of the diabetic foot syndrome. It was established, that application of an active surgical tactic using cutaneo-adipose flap of their own and cellular culture of fibroblasts on the background of selective prolonged intraarterial complex therapy permits to perform economic amputation of foot, reduces risk of performance of high amputation of the lower extremity and reoperations.