scholarly journals CONTRIBUTION OF TRANSCUTANEOUS OXYMETRY IN DIABETIC FOOT SYNDROME

2013 ◽  
Vol 1 ◽  
pp. 307-313
Author(s):  
Ludovit Gaspar ◽  
Matej Bendzala ◽  
Andrea Komornikova ◽  
Ivan Ocadlik ◽  
Michal Makovnik ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Diabetic Foot ◽  
Ultrasound Examination ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Arterial Calcification ◽  
Primary Position ◽  
Transcutaneous Oxygen ◽  
Peripheral Arterial

Four major complications are participating in tissue damage in diabetic foot syndrome – diabetic angiopathy, neuropathy, osteoarthropathy and inflammation. Low ankle-brachial pressure index (ABI) is a well-known indicator for ischemia of lower limbs, but in patients with diabetes mellitus is common also a high ABI (over 1.3) as reliable predictor of the presence of arterial calcification – medial calcinosis. Aim of the study is to determine the degree of ischemia using transcutaneous oximetry in patients with diabetic foot syndrome - with clinical manifestations of peripheral arterial occlusive disease (PAOD) and medial calcinosis. We investigated three groups: first consisted of 46 members in IInd stage of PAOD according to Fontaine classification, in second group were 30 members in IIIrd stage of PAOD and third had 29 members in IVth stage of PAOD. The ABI was determined with Doppler ultrasound examination. Transcutaneous oxygen tension (TcPO2) was measured with Oxykapnomonitor Hellige SMK Germany equipment with sensing probe – transoxode. Resting values of TcPO2 were obtained in lying patient on the foot in first metatarsal space. Subsequently leg was passively elevated into 30 degree angle for 3 minutes and then reimposed into primary position. One minute exercise – plantar and dorsal feet flexion was performed and after the TcPO2 values stabilization the patient hung his shin from the edge of the bed touching the floor. TcPO2 values were continuously recorded by analog waveform. In more severe stages of PAOD according to Fontaine stage III and IV we detected lower levels of TcPO2 under basal resting conditions: 20 respectively 5 mmHg. Patients with IInd stage of PAOD had basal TcPO2 values of 40 mmHg. Conclusions of the study are: TcPO2 values are not affected by the presence of medial calcinosis and sothis method is particularly beneficial in patients where Doppler ultrasound examination shows artificial high pressure values on lower limbs. In the third and fourth stage of PAOD passive leg elevation is as effective in determination of ischemia as working test.

scholarly journals Assessment of Diabetic Foot through the Developmental Stages of Lower Limb Abnormalities Using Ultrasound

2020 ◽  
Author(s):  
Suresh K.S. ◽  
Sukesh Kumar A.
Keyword(s):  
Blood Pressure ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Developmental Stages ◽  
Systolic Pressure ◽  
Arterial Calcification ◽  
Velocity Spectrum ◽  
Transcutaneous Oxygen ◽  
Peripheral Arterial ◽  
Medial Arterial Calcification

A diabetic foot is one of the most serious complications of diabetes mellitus. This causes large number of lower leg amputations worldwide. Usually this disease is getting diagnosed in a very later stage. Ankle-arm index, diastolic blood pressure, fasting plasma glucose, hemoglobin A1C, high blood pressure, medial arterial calcification, nerve conduction velocity, peripheral vascular disease, systolic blood pressure, transcutaneous oxygen tension, etc. are some of the major indicators of a diabetic foot. Among these peripheral arterial abnormalities and neuropathy are the most dominant visible factors. Detection and monitoring of diabetic foot help to demonstrate the feet at risk of ulceration positively. This study reveals the various assessment methodologies of lower limb abnormalities leading to diabetic foot using ultrasound. Ultrasound is being used in various cases related to diabetic foot, from the identification of systolic pressure for the ankle brachial pressure index to the velocity analysis of hemodynamic studies. The study analyses the lower limb abnormalities and extracts the features of diabetic foot from the velocity spectrum of ultrasound Doppler scan.

Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽  
2021 ◽  
pp. 000331972110426
Author(s):  
Martyna Schönborn ◽  
Patrycja Łączak ◽  
Paweł Pasieka ◽  
Sebastian Borys ◽  
Anna Płotek ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Healing Process ◽  
Arterial Disease ◽  
Angiogenic Factors ◽  
Diabetic Foot Syndrome ◽  
Tissue Loss ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Impaired Wound Healing ◽  
Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

scholarly journals Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome

2019 ◽  
Vol 74 (4) ◽  
pp. 283-288
Author(s):  
Petr A. Gerasimchuk ◽  
Alexander V. Shidlovskyi ◽  
Dmitriy B. Fira ◽  
Andrey V. Pavlyshyn
Keyword(s):  
Diabetes Mellitus ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Chronic Wound ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Vacuum Therapy ◽  
Social Significance ◽  
Number Of Patients ◽  
Bed Days

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.625% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 1525% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy. Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion. Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 20142017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound. Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 7080 mm Hg, which makes it possible to stop pain during the day. At 23 days of the postoperative period, negative pressure is established at standard values. Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.31.7) bed-days, and patients with ischemic form ― on average (4.11.9) bed-days, which has both medical and social significance.

scholarly journals Wound-directed revascularisation in the Diabetic Foot patients

2016 ◽  
Vol 6 (6) ◽  
pp. 722-731
Author(s):  
N. Kononenko ◽  
A. Sheikhali
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Arterial Disease ◽  
Term Treatment ◽  
Lower Limbs ◽  
Long Term Treatment ◽  
Peripheral Arterial Diseases ◽  
Foot Lesions ◽  
One Year ◽  
Peripheral Arterial

Introduction: Peripheral arterial diseases in patients with diabetic foot have significant features in pathogenesis, manifestations and course compared with peripheral arterial disease. These features require different approaches to treatment and the the angiosome theory can help increase the effectiveness of revascularization in patients with diabetic foot. The aim: Analyse the results of revascularisation of lower extremity arteries in the patients with ischemic diabetic foot ulcers according to the angiosome theory. Materials and metods: We analysed 98 revascularisations of arteries of 77 lower limbs in 74 ischemic diabetic foot patients for the period from 2017 to 2021. Angioplasties were performed in 71 cases (72,5%), open operations – in 21 (21,4%), hybrid operations – 6 (6,1%). According to angiosome theory we divided the revascularizations into two groups. І group – direct revascularizations (DR) – 57 cases, ІІ group – indirect revascurizations (IR) – 21 cases. Results: Within 6 months foot lesions healing fixed in І group (DR) - 81.7%, in ІІ group (IR) – 78.6%. Major amputations were the consequences of 17,1% revascularizations: DR group – 12,4%, IR group – 33,3%. Functional capacity of the lower extremity within one year was saved in 79,3% in DR group and in 57,9% in IR group. Repeated revascularizations accounted for 21,4% of cases: in DR group – 20,5%, in IR group – 25%. The results of the statistical analysis revealed the dependence of the risk of amputation on adherence to angiosome theory during revascularization. Conclusions: Angiosome-targeted revascularization in the area of foot lesions increases efficiency of the revascularization and improves immediate and long-term treatment results.

scholarly journals Pharmacological therapy in critically ill patients with peripheral and concomitant arteriopathy

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 166-173
Author(s):  
Nicola Troisi ◽  
Antonio Trani ◽  
Pierluigi Antonino Cappiello
Keyword(s):  
Peripheral Arterial Disease ◽  
Clinical Manifestations ◽  
Arterial Disease ◽  
Risk Profile ◽  
Pharmacological Therapy ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Critical Ischemia ◽  
Good Safety Profile ◽  
Peripheral Arterial

Peripheral arterial disease is one of the most frequent clinical manifestations of atherosclerotic disease. The clinical picture of critical ischemia of the lower limbs is often burdened by high mortality and the risk of limb amputation. The direct and indirect prostanoids, and in particular iloprost and cilostazol, are effective in the medical treatment of peripheral arterial disease. We describe here five clinical cases in which iloprost and cilostazol have been successfully administered in arterial patients with various concomitant cardiovascular diseases, highlighting a good safety profile in relation to the cardiocascular risk profile (Cardiology).

scholarly journals The significance of electrothermometry indices for organization of adequate infusion therapy in diabetic foot syndrome

2012 ◽  
Vol 93 (2) ◽  
pp. 389-390
Author(s):  
R I Fatykhov ◽  
I V Klyushkin ◽  
L A Akhmetyanov
Keyword(s):  
Clinical Data ◽  
Diabetic Foot ◽  
Conservative Therapy ◽  
Dynamic Control ◽  
Diagnostic Procedures ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Infusion Therapy ◽  
Subsequent Formation ◽  
Tissue Ischemia

Aim. To determine the criteria for conservative infusion therapy with the assessment of its effectiveness using the electrothermometry method. Methods. One of the major complications of diabetes is the diabetic foot syndrome. This diagnosis is established on the basis of clinical data and imaging studies. The resulting parameters are objective, but the specificity, selectivity, and the multiplicity of diagnostic procedures negate the effectiveness of these methods, making it difficult to consequently form treatment strategy. Registration of temperature parameters during different degrees of ischemic disturbances of the lower limbs by electrothermometry was performed with the subsequent formation of the algorithm of conservative therapy. Results. In patients with diabetic foot syndrome determined was the direct correlation between the degree of tissue ischemia of the lower extremities and the variation of temperature parameters. The formation of the course of conservative therapy was performed after evaluating the obtained parameters; its formation was based on the main pathogenetic links. Clinical data and the parameters of electrothermometry served as the method of dynamic control. Conclusion. Despite the achieved successes in the modern diagnosis of the diabetic foot syndrome, there still remains a number of inaccuracies, the key ones among then are the difficulties associated with determining the level of trophic disorders; electrothermometry makes it possible to expand the diagnostic horizons, and the obtained result can serve as a prognostic guide for the formation of the tactics of therapy and as a method of dynamic control.

scholarly journals A diabeteses láb ischaemiás eredete. Epidemiológia, a diagnózis nehézségei, prevenciós és revascularisatiós lehetőségek

2017 ◽  
Vol 158 (6) ◽  
pp. 203-211 ◽  
Author(s):  
Endre Kolossváry ◽  
Zoltán Bánsághi ◽  
Gábor Viktor Szabó ◽  
Zoltán Járai ◽  
Katalin Farkas
Keyword(s):  
Peripheral Arterial Disease ◽  
Diabetic Foot ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diagnostic Tools ◽  
Public Health Issue ◽  
Effective Prevention ◽  
Increased Risk ◽  
Peripheral Arterial

Abstract: “Diabetic foot” as definition covers a multifactorial clinical condition. According to the recent epidemiological data, the role of lower limb ischemia is getting more influential over other pathological causes, like neuropathy, infections and bone or soft tissue deformity. In diabetes, vascular disease leads to increased risk for leg ulcers and minor or major amputations. The traditional diagnostic tools for recognition of peripheral arterial disease have limited value because of diabetes specific clinical manifestations. Available vascular centers with special expertise and diagnostic tools are the prerequisite for efficient diagnosis supporting timely recognition of peripheral arterial disease. In course of treatment of diabetic foot with ischemic origin, beyond effective medical treatment revascularization (open vascular surgery or endovascular procedures) has paramount importance for prevention of limb loss. Vascular teams of vascular specialists, vascular surgeons and interventional radiologist in dedicated centers in multidisciplinary cooperation with other professions represent public health issue in effective prevention. Orv. Hetil., 2017, 158(6), 203–211.

scholarly journals MICROBIAL COMPOSITION OF PURULENT LESIONS IN PATIENTS WITH COMPLICATED DIABETIC FOOT SYNDROME

2019 ◽  
Vol 18 (4) ◽  
pp. 11-16
Author(s):  
S. D. Shapoval ◽  
I. L. Savon ◽  
O. V. Trybushnyy ◽  
L. A. Vasylevsʹka ◽  
L. Yu. Slobodchenko ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Lower Limbs ◽  
Microbial Pathogens ◽  
Diabetic Foot Syndrome ◽  
Microbial Composition ◽  
Quick Method ◽  
Microbial Cells ◽  
Foot Complications ◽  
High Level ◽  
Further Development

Bacterial infection is a major pathogenetic aspects in the formation of diabetic foot complications. Joining infection is the cause of performing amputations of the lower limbs in 25-72 % of cases, especially when diabetic foot is complicated by sepsis. The aim of our study was to identify differences in the microbial background of purulent foci in patients with diabetic foot syndrome complicated by sepsis and for the further development of the algorithm of directed antibiotic therapy. Material and methods. A total of 3653 patients in the dynamics of a complicated diabetic foot syndrome were examined. There were two groups: the first - patients who were treated during 2010-2014 (a comparison group), the second – during 2015-2019 (main group), which according to the gender ratio (χ2=0.09; P=0.7698) and age (P=0.17141) did not differ. The complex bacteriological studies consisted of determining the sensitivity of microorganisms to antibiotics, the qualitative composition of microbial pathogens and the number of microbial cells per 1 g of tissues. To determine the sensitivity of purulent microorganisms to antibiotics a quick method of determination on automated systems «Vitek-2» and «BacT/ ALERT» (France) was applied. Results and discussion. All patients with complicated diabetic foot syndrome were operated under general anesthesia. As a rule, operations on the anterior foot and «high» amputations were performed. 190 people died, death rate was 5.2 %. The analyzed data indicate that in patients with diabetic foot syndrome complicated by the number of microbial cells in tissue 1g to the site of infection did not exceed 105 – 106, while in patients with sepsis, this number was more than 50% was 107 – 1012. Isolation of aerobic monoinfection of purulent foci in patients with complicated diabetic foot syndrome in the period from 2010 to 2019 decreased from 51,4 to 44,4% (P <0,05) determined by an increase in the allocation of gram-positive microorganisms from 55,2 to 60,2% (P<0,05). The dynamics of microbiological research indicates an increase in the proportion of MRSA- staphylococci from 23,4 to 43,3 %. Determined microbial pathogens are characterized by a high level of antibiotic resistance, particularly to antibiotic-I-II generation. Conclusions. These experiments enable to distinguish particularly microbial background of purulent foci of the two groups of patients and determine antibiotic algorithms.

New possibilities of maximal revascularization of the foot as a limb salvage procedure in diabetics

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 278-283 ◽  
Author(s):  
Sauvant ◽  
Hüttenmoser ◽  
Soyka ◽  
Rüttimann
Keyword(s):  
Diabetic Foot ◽  
Arterial Disease ◽  
Major Amputation ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Salvage Procedure ◽  
Critical Ischemia ◽  
Peripheral Arterial

Diabetics and patients with chronic renal insufficiency often have severe peripheral arterial disease of the distal lower limbs with obstructions of crural and pedal arteries and the imminent risk of critical ischemia and major amputation. Neuroischemic foot ulcers have been shown to fail to heal even after successful arterial revascularization. We report on two diabetic patients with the neuroischemic diabetic foot syndrome and different clinical outcomes after percutaneous transluminal angioplasty of chronic occluded crural arteries and discuss, whether endovascular revascularisation of infrapopliteal and pedal arteries, if possible with complete plantar arch, could promote ulcer healing in neuroischemic diabetic foot ulcers.

Sign in / Sign up

Export Citation Format

Share Document