scholarly journals Epidermis of amputated limbs in patients with diabetes mellitus - immunohistochemical study

2014 ◽  
Vol 95 (2) ◽  
pp. 244-249
Author(s):  
G N Gorshunova ◽  
R A Dzamukov ◽  
V V Valiullin
Keyword(s):  
Diabetic Foot ◽  
Epidermal Cells ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Nuclear Antigen ◽  
Healthy Controls ◽  
Color Intensity ◽  
Patients With Diabetes ◽  
Apoptotic Activity ◽  
Skin Samples

Aim. To examine the skin morphological changes in different areas of the amputated lower limbs of patients with diabetes mellitus. Methods. Skin samples of lower limbs of 6 patients with diabetic foot syndrome were studied using immunohistochemistry methods. Proliferation of epidermal cells, their resistance to apoptosis, as well as the degree of cells differentiation (using antibodies to proliferating сell nuclear antigen, Bcl-2 anti-apoptotic activity marker, epidermal cells terminal differentiation marker cytokeratin 1) were assessed. The color intensity was assessed using ImageJ software and was displayed as «mean greyscale intensity» (an integral value summarizing color intensity of three basic colors - red, green and blue - by V=0,299R+0,587G+0,114B formula, where V - mean intensity of a mean pixel, R, G, B - color intensity of red, green and blue pixels appropriately). Results. Patients with diabetic foot syndrome had reduced proliferative activity of epidermal cells as they approach the sphacelous area of the affected limb, together with decreased resistance to apoptosis in the same areas. The share of cells positive for proliferating cell nuclear antigen was 58.74±4.8% in skin samples from the area of necrosis (n=6) compared to 77.41±3% (p 0.005) in skin samples of the healthy controls. The study of Bcl-2 marker expression by cells of the sphacelous area (n=6) revealed that mean greyscale intensity in patients with diabetic foot syndrome was 57.74±4.3, which was significantly lower compared to skin samples of the healthy controls (n=6, 89.69±3.4, p 0.005). Based on the expression of cytokeratin, it was shown that suprabasal layers of the epidermis cells were less differentiated in case of diabetic foot syndrome compared to the same cells of the epidermis of the control group. Conclusion. In advanced stages of diabetes, the combined effect of the disease is reduced number of epidermis proliferating cells, the reduction of their anti-apoptotic activity and loss of skin as an organ.

scholarly journals The use of NPWT in combination with silver dressing in diabetic foot syndrome – case report

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Dominik Andrzej Walczak ◽  
Rajmund Jaguścik ◽  
Karolina Ptasińska ◽  
Leokadia Kozaczek ◽  
Piotr Wojciech Trzeciak
Keyword(s):  
Case Report ◽  
Diabetic Foot ◽  
Negative Pressure Wound Therapy ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Healthy Individuals ◽  
Wound Therapy ◽  
Present Case Report ◽  
Increased Risk ◽  
Patients With Diabetes

Patients with diabetes mellitus are at increased risk of angiopathy, neuropathy and infection compared with healthy individuals and that may lead to foot disorders. Treatment is difficult challenging and if it is not successful it often run to lower limbs amputations.We present case report of 63 years old man after amputation of big toe and part of metatarsus due to diabetic foot syndrome, successfully treated with negative pressure wound therapy in combination with silver dressing. The literature regarding this issue was also reviewed.

scholarly journals Sepsis as a cause of fatal cases after the lower limbs amputation at the hip level due to gangrene in patients with a diabetic foot syndrome

2019 ◽  
Vol 41 part 1 (2) ◽  
pp. 29-35
Author(s):  
A. V. Kapshitar ◽  
A. A. Kapshitar
Keyword(s):  
Myocardial Infarction ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Limb Amputation ◽  
Pathological Changes ◽  
Educational Work ◽  
Severe Diabetes ◽  
Patients With Diabetes

Purpose of the study. To study frequency of fatal sepsis, the causes and severity of diabetes patients complicated by diabetic foot syndrome of the gangrene limb, after amputation of the lower limb at the hip level. Material and methods. Amputation of the lower limb at the hip level was performed in 180 patients with diabetic foot, gangrene of the limb. 15 (8,3%) died. Results. From the 15 patients who died, 9 died from sepsis. The age was 54–78 years old. On admission, sepsis was diagnosed in 5 and septic shock – in 4 patients. After examination and preparation, emergency surgeries were performed in 4 patients and urgent surgeries – in 5. Two- and three-step surgeries were performed in 5 patients. They first performed the removal of the toes of the gangrene, osteomyelitis, opened deep phlegmon of the foot and the lower leg was completed by amputation of the lower limb. Primary amputations were performed in 4 patients. Sepsis was the cause of death in 5 patients from 11 to 60 days and the combinations of sepsis with acute myocardial infarction or repeated myocardial infarction – in 4 from 5 to 17 days. During the autopsy, pathological changes of severe diabetes, complicated diabetic foot syndrome, its mixed form, sepsis with manifestations of septicemia or septicopyjemia, and all organs and systems were revealed. Conclusions. The unsatisfactory organization of medical care for patients with diabetes and diabetic foot syndrome at the pre hospital stage, ineffective sanitary and educational work, systemic pathological changes led to sepsis and death after the amputation of the lower limb at the hip level. Keywords: sepsis, diabetic foot syndrome, limb amputation, mortality.

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 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 Diabetic foot syndrome in patients with diabetes. A multicenter German/Austrian DPV analysis on 33 870 patients

2018 ◽  
Vol 34 (6) ◽  
pp. e3020 ◽  
Author(s):  
Barbara Bohn ◽  
Arthur Grünerbel ◽  
Marcus Altmeier ◽  
Carsten Giesche ◽  
Martin Pfeifer ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes

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 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 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.

The results of diabetic foot syndrome screening among rural patients with diabetes in Uzbekistan

2019 ◽  
Author(s):  
Nilufar Ibragimova ◽  
Khamidulla Shakirov ◽  
Bakhodir Babakhanov ◽  
Lyudmila Kokareva ◽  
Oksana Platonova
Keyword(s):  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Rural Patients
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