scholarly journals The process of repair of trophic ulcers in patients with diabetes

2004 ◽  
Vol 50 (2) ◽  
pp. 34-38
Author(s):  
N. A. Myskina ◽  
A. Yu. Tokmakova ◽  
M. B. Antsiferov
Keyword(s):  
Diabetes Mellitus ◽  
Blood Flow ◽  
Diabetic Foot ◽  
Neurological Disorders ◽  
Sharp Increase ◽  
Lower Extremities ◽  
Late Complications ◽  
Diabetic Foot Syndrome ◽  
Industrialized Countries ◽  
Patients With Diabetes

In the last 30 years, there has been a sharp increase in the incidence of diabetes mellitus (DM), especially in industrialized countries, and its prevalence tends to further increase [3]. The main cause of disability and death of patients are late complications of this disease. Among them, it is especially important to identify developing diabetic foot syndrome (DFS), which is defined as infection, ulcer and / or destruction of deep tissues, associated with neurological disorders and decreased main blood flow in the arteries of the lower extremities of varying degrees severity (International Diabetic Foot Agreement, Netherlands, 1999)

scholarly journals Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

2021 ◽  
Vol 27 (3) ◽  
pp. 22-28
Author(s):  
Yu.M. Babina ◽  
D.V. Dmyrtriiev ◽  
O.A. Nazarchuk ◽  
P.P. Hormash
Keyword(s):  
Diabetes Mellitus ◽  
Wound Healing ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Povidone Iodine ◽  
Local Treatment ◽  
Lower Extremities ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

Technique of Atypical Amputation of the Foot in Patients with a Complicated Course of Diabetic Foot Syndrome

2015 ◽  
Vol 22 (3) ◽  
pp. 43-49 ◽  
Author(s):  
Гвазава ◽  
T. Gvazava
Keyword(s):  
Diabetes Mellitus ◽  
Blood Flow ◽  
Diabetic Foot ◽  
Blood Circulation ◽  
Lower Extremities ◽  
Duplex Ultrasound ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Ultrasound Study ◽  
Complicated Course

Abstract. Introduction. Diabetes mellitus is one of the most common and socially important diseases in the world. The diabetic foot syndrome is one of the most complex diseases with a view to pathogenesis and one of the most serious complications of diabetes mellitus. This syndrome is characterized by disorders and changes of all structures of lower extremities, causes the ulcerous and necrotic processes. At the current moment, a traditional method in treatment of complications of the diabetic foot syndrome is amputation of lower extremities. Due to the large number of postoperative complications, the most preferable are economic amputations at the level of foot step. In modern conditions in the first stage of complex treatment of patients with purulent-necrotic process in the lower extremities, the recovery of main arterial blood circulation of the lower extremities in the form of open or endovascular angioplasty is effective. The most effective method is revascularization performed according to angiosomes areas of blood flow in footstep. Purpose of this study is to carry out a comparative assessment of the effectiveness of typical and atypical amputations at the level of footstep in patients with the most complicated course of the diabetic foot syndrome. Material. The objects of this study were patients with diabetes mellitus (DM) type 2 with purulent-necrotic complications of diabetic foot, treated at the surgical department department of the National N.I. Pirogov Surgical and Medical Center of the Saint- Petersburg of the SPb Clinical centre for the period 2010-2013. The main group included 68 patients. These patients were performed atypical interventions according to angiosomes blood flow to the tissues of the foot. Operative interventions at the level of footstep were carried out to 47 patients of the control group. Methods. An objective study to assess the local status, laboratory tests (clinical blood test, basic coagulogram, carbohydrate metabolism indexes) and duplex ultrasound study (USDI) of vessels of lower extremities were carried out. Obligatory angiography was performed in all patients. Surgical intervention in the form of dissection, drainage of purulent focus was carried out on an emergency basis prior to angiography only in patients with acute purulent processes in the lower extremities. In all other cases, the individual peculiarities of blood circulation disorder in lower extremities determined the choice of tactics of operative treatment. In 76% and 46% accordingly for each group after angiography, a balloon angioplasty was carried out for reconstruction of the main blood flow. Results and discussion. The average duration of the in-patient treatment in study group was 14,4±2,3. In the control group - 18,2±3,1. Duration of hospitalization differed significantly (p<0.05), but significant group of patients (31 and 18, respectively) were re-hospitalized during the period from 2 to 6 weeks after discharge from the hospital for the purpose of autodermoplasty for closure of surgical wounds. There were no significant differences between the postoperative healing time of wounds and wound surfaces after reconstructive interventions. This indicates the correct choice and method of operation, as well as indications for secondary wound closure. The authors note the difference in number of re-operations for recurrent purulent-necrotic process (2 patients in the study group and 9 patients in the control group). Re-operation was considered in the case of a destructive process to heal the original wound. Relapse necrotic phenomena was the main cause of the increase in terms of the impossibility of independent movement and 6.3±1,2 and 13.1±3.4 days, respectively (p<0.05). The authors explain these results by the fact that the leading role belongs to the qualitative blood circulation of paravulnar tissues in the postoperative wound healing in patients with diabetic foot syndrome. Conclusions. 1. Preoperative angiography is prescribed to patients with purulent-necrotic complications of diabetic foot syndrome. If required, angioplasty before performing surgery on the tissues of the feet. 2. The application of the principle angiosomes blood flow on the basis of the duplex ultrasound study (USDI) of arteries and angiography allows to choose the most rational tactics of surgical treatment. 3. The use of atypical technique of amputations in the foot after preoperative examination can reduce the number of postoperative complications and the duration of inpatient treatment, to improve postoperative mobility and difficulty walking patients.

scholarly journals Possibilities of combined surgical treatment of pyonecrotic lesions in the neuroischemic form of diabetic foot syndrome

2009 ◽  
Vol 12 (1) ◽  
pp. 8-13
Author(s):  
Valeriy Afanas'evich Mitish ◽  
I A Eroshkin ◽  
Gagik Radikovich Galstyan ◽  
Lyudmila Petrovna Doronina ◽  
Yu S Paskhalova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Lower Extremities ◽  
Lower Leg ◽  
Diabetic Foot Syndrome ◽  
Diagnostic Tools ◽  
Critical Ischemia ◽  
Adequate Treatment ◽  
Patients With Diabetes ◽  
Foot Lesions

Aim. To present results of combined surgical treatment of the ischemic form of diabetic foot syndrome complicated by pyonecrotic process. To show thatthe use of modern diagnostic tools and the choice of adequate treatment strategy permits to substantially reduce the number of above-the-knee amputations. Materials and methods. A total of 140 patients with diabetes mellitus and critical ischemia of lower extremities were under observation during 2004-2008.All of them had purulent and/or necrotic foot lesions. The patients were examined by X-ray, computed and magneto-resonance tomography of the feet,duplex scanning of lower leg vasculature, transcutaneous measurement of PO2, pelvic and lower leg arterial angiography. Results. A strategy of surgical treatment was developed to be used depending on the patients health status, clinical features and severity of pyonecroticprocesses in the foot, and the degree of involvement of the main blood vessels of lower extremities. Conclusion. Combination of endovascular surgery with various methods for plastic wound closure permits to extend the range of possibilities for the treatmentof high-risk patients, such as those with pyonecrotic lesions and neuroischemic form of diabetic foot syndrome. This approach opens up prospects fora significant decrease of percentage of above-the-knee amputations and improves the quality of life in these patients.

scholarly journals Bubbling Treatment Option in the Complex Therapy of Diabetic Foot Syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. 210-215
Author(s):  
Anton Petrovich Ostroushko ◽  
Alexander Alekseevich Andreev ◽  
Alexander Alexandrovich Shmarin ◽  
Vladislav Valeryevich Novomlinsky ◽  
Anastasia Yurievna Laptiyova ◽  
...  
Keyword(s):  
Treatment Option ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Treatment Method ◽  
Late Complications ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Results Of Treatment ◽  
Patients With Diabetes ◽  
After Cancer

Diabetes mellitus (DM) is the most common and socially significant endocrine disease that leads to early disability and is the most common cause of mortality in patients after cancer and cardiovascular pathology. The cost of managing patients with diabetes can reach 30% of the country's health budget, 90% of which is spent on the treatment of its complications. Diabetic foot syndrome (DFS) is developed in 20-80% of patients and is one of the most dangerous late complications. In clinical practice, various approaches to its treatment are used, but the number of high amputation and mortality rate in this group of patients remains significant. The aim of the study was to improve the results of treatment of patients with diabetic foot syndrome (DFS) by including the bubbling treatment method in the program of therapeutic measures. Forty-eight patients with neuropathic and neuroischemic forms of DFS were treated. The control group consisted of 23 patients receiving conventional treatment, the main group included 26 patients, who were applied bubbling treatment option locally. The analysis of groups of patients showed no significant differences by gender, age, stages of diabetic foot syndrome, depth of necrotic defect, complications and concomitant diseases. The use of the bubbling treatment method in the complex treatment of patients with DFS allowed more effectively arresting symptoms of local (edema, hyperemia, wound exudate, necrolysis) and general inflammation, anemia and intoxication syndromes, contributed to the activation of regeneration processes in soft tissues, which, combined with complex FDS treatment, together, reduced the number of amputations by 18.7%.

scholarly journals Peculiarities Of Treatment Of Purulent-Necrotic Complications In Patients With Diabetic Foot Syndrome

2021 ◽  
Vol 03 (06) ◽  
pp. 116-121
Author(s):  
Abdullaev R.N. ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Septic Complications ◽  
Complications Of Diabetes ◽  
Surgical Infection ◽  
Number Of Patients ◽  
Patients With Diabetes

The number of patients with diabetes mellitus in the Andijan region who were registered according to endocrinologists from 2000 to 2015 increased almost fourfold from 26,000 to more than 110,000 in 2016 (14). This also shows that the number of patients with various purulent-necrotic complications of diabetes mellitus also increases proportionally, in addition, there is an increase in patients with severe purulent-septic complications of these processes, with widespread, deep purulent-necrotic fasciitis [3]. Of patients in the department of surgical infection of the ASMI clinic, patients with purulent-necrotic complications of diabetes mellitus account for almost 78%, which indicates a significant increase in the number of these patients. This tendency continues and goes up every year. According to the WHO, by 2030 every 15 people will have diabetes, and by 2050 this figure will be equal to every 6 people.

scholarly journals Integrated surgical management of neuroischemic diabetic foot syndrome, abdominal aortic aneurysm and renal artery lesionsin patients with diabetes mellitus type 2

2011 ◽  
Vol 14 (4) ◽  
pp. 100-106
Author(s):  
Sergey Anatol'evich Terekhin ◽  
Victor Afanas'evich Kalashnikov ◽  
Valeriy Afanas'evich Mitish ◽  
Lyudmila Petrovna Doronina ◽  
Alla Yur'evna Tokmakova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Abdominal Aortic Aneurysm ◽  
Surgical Management ◽  
Diabetic Foot ◽  
Diabetes Mellitus Type 2 ◽  
Diabetic Foot Syndrome ◽  
Abdominal Aortic ◽  
Patients With Diabetes

The article presents a clinical example of integrated surgical management in patient with multifocal atherosclerosis, chronic kidney disease andneuro-ischemic form of diabetic foot syndrome

scholarly journals THE PREVALENCE OF MODIFIABLE RISK FACTORS IN THE POPULATION AND IN PATIENTS WITH DIABETES MELLITES, INCLUDING DIABETIC FOOT SYNDROME

2020 ◽  
Vol 23 (2) ◽  
pp. 85-91
Author(s):  
T. Yu. Kravtsova ◽  
M. F. Zarivchatskiy ◽  
P. S. Lukin ◽  
S. F. Blinov ◽  
M. V. Bacheva
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Foot ◽  
Age Groups ◽  
Social Study ◽  
Diabetic Foot Syndrome ◽  
Modifiable Risk Factors ◽  
Patients With Diabetes ◽  
Poor Nutrition

Goal of work - identify modifiable risk factors for chronic non-infectious diseases in patients with type 2 diabetes mellitus and in the formation of diabetic foot syndrome. Material and methods. A comparative medical and social study was conducted - a survey of patients in clinics of the city of Perm, suffering and not suffering from diabetes. The study involved 230 people who were assigned according to the presence/absence of diabetes mellitus. The first group included 178 patients with an average age of 45.8 (30.0; 59.0). The second group included 27 patients with diabetes mellitus, with an average age of 61.7 years (50.0; 62.0). The third group included 25 patients with diabetic foot syndrome, whose average age was 64.72 years (61.0; 69.0). Women predominated in all groups. Original and generally accepted questionnaires were used to study the presence of common risk factors for chronic diseases among respondents. Results. The analysis of the studied materials showed a clear qualitative and quantitative pattern of accumulation of risk factors in the age exponent. Most risk factors tend to grow up to 54-65 years. Risk factors such as smoking, alcohol abuse, poor nutrition and overweight, depression and hypertension predominate (р<0,05) in older age groups of respondents. In patients with diabetes mellitus, low physical activity, poor nutrition, and obesity predominate (р<0,05). In patients with diabetic foot syndrome, the same risk factors were identified as in patients without this pathology. At the same time, in respondents with diabetic foot syndrome, physical activity was minimal, and body mass index values were much higher (р<0,05); in addition, patients with diabetic foot syndrome are more likely (р<0,05) to be depressed and perceive their health as «very poor.»

scholarly journals M.I. Akhunbaev, A.P. Kalinin, D.S. Rafibekov. Diabetic angiopathy of the lower extremities and diabetic foot. - Bishkek, 1997 .-- 143 p.

2019 ◽  
Vol 45 (1) ◽  
pp. 56-56
Author(s):  
M. N. Solun
Keyword(s):  
Diabetes Mellitus ◽  
Adverse Effect ◽  
Diabetic Foot ◽  
Lower Extremities ◽  
Premature Death ◽  
Diabetic Angiopathy ◽  
Patients With Diabetes

The monograph under review is devoted to one of the most important sections of clinical diabetology. As you know, damage to the lower extremities in patients with diabetes mellitus (DM) is quite common and has an adverse effect on the fate of patients, causing their early disability, and in some cases premature death.

scholarly journals INCREASING FOOT CIRCULATION WITH ELECTRICAL STIMULATION IN PATIENTS WITH DIABETES MELLITUS

2018 ◽  
Vol 4 (3) ◽  
pp. 343-349
Author(s):  
Iskandar Iskandar ◽  
Ridha Dharmajaya ◽  
Yesi Ariani
Keyword(s):  
Diabetes Mellitus ◽  
Blood Flow ◽  
Electrical Stimulation ◽  
Blood Vessels ◽  
Diabetic Foot ◽  
Ankle Brachial Index ◽  
Sampling Technique ◽  
Calf Muscle ◽  
Patients With Diabetes ◽  
Peripheral Arterial

Background: Peripheral arterial disorders in diabetes mellitus is a common complication that often occurs and can develop into diabetic foot ulcers. High blood sugar levels in people with diabetes mellitus can cause increased blood viscosity resulting in thickening of the capillary membrane, where erythrocytes, platelets and leucocytes are attached to the blood vessels. Electrical stimulation by placing electrodes in the calf muscle is one of the measures to increase foot blood flow that can reduce the poor foot circulation.Objective: This study aims to determine the effect of electrical stimulation in improving blood flow of patients with diabetes mellitus.Methods: The research use one-group pretest-posttest pre-experimental design. Sampling technique using pusposive sampling as many as 62 patients with diabetes mellitus. Electrical stimulation is done by attaching electrodes to left and right calf muscles for 20 minutes, frequency 3 times a week for 2 weeks. Before and after electrical stimulation performed foot circulation examination by ankle brachial index technique. Data analysis using Wilcoxon signed rank test.Results: The results showed that before the stimulation was obtained the mean ankle brakhial index 0.82 mmHg and after stimulation 0.95 mmHg (p = 0.000), meaning there is an effect of electrical stimulation in increasing foot blood flow. A calf muscle contraction during stimulation leads to increased leg blood flow through the addition of vascular endothelial growth factor and increased nitric oxide as a vasodilator of blood vessels. Electrical stimulation can be applied in increasing the blood flow of the foot, thus preventing the occurrence of diabetic foot ulcers.Conclusion: Stimulation is one therapy that can be done to prevent poor foot circulation of diabetes mellitus patients. 

Severe Vitamin D3 Deficiency in the Majority of Patients with Diabetic Foot Ulcers

2018 ◽  
Vol 50 (08) ◽  
pp. 615-619 ◽  
Author(s):  
Joachim Feldkamp ◽  
Karsten Jungheim ◽  
Matthias Schott ◽  
Beatrix Jacobs ◽  
Michael Roden
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Cell Function ◽  
Glycosylated Hemoglobin ◽  
Diabetic Foot Syndrome ◽  
Foot Ulcers ◽  
Control Group ◽  
Diabetic Foot Ulcers ◽  
Healthy Humans ◽  
Patients With Diabetes

AbstractDiabetic foot ulcers are a severe complication in patients with diabetes mellitus. Vitamin D is associated with impaired β-cell function and insulin resistance, and is necessary for wound healing and bone metabolism. We measured the serum concentrations of 25-hydroxyvitamin D3 in 104 patients (63 inpatients, 41 outpatients) with diabetic foot ulcers and compared them to 99 healthy humans (control) and 103 patients with diabetes mellitus type 2 without diabetic foot ulcers. Calcium, creatinine, and parathyroid hormone were measured in patients with diabetic foot ulcers. The data were analysed together with glycosylated hemoglobin A1c and the severity of diabetic foot lesions according to the Armstrong classification. Levels of 25-hydroxyvitamin D3 were lower (11.8±11.3 ng/ml, p<0.001) in patients with diabetic foot ulcers (mean age 70±12 years) than in the control group (27.2±12.2 ng/ml). No difference was found between in- and outpatients. Fifty-eight (55.8%) of patients with diabetic foot ulcers had a severe 25-hydroxyvitamin D3 deficiency with levels below 10 ng/ml. Only 12% of the patients had 25-hydroxyvitamin D3 levels above 20 ng/ml. Secondary hyperparathyroidism was found in 27.9% of patients and 11.5% of the patients were hypocalcemic. There was a negative correlation (r=–0.241) (p<00.1) between Armstrong classification and 25-hydroxyvitamin D3 status. In conclusion, patients with diabetic foot syndrome are at high risk of 25-hydroxyvitamin D3 deficiency. Thus, any patient with diabetic foot syndrome should undergo 25-hydroxyvitamin D3 measurement and supplementation, if values are found to be decreased.

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