scholarly journals Diagnostic and treatment principles of wound process in patients with diabetic foot syndrome and risk groups. Draft recommendations

2021 ◽  
pp. 109-123
Author(s):  
A. A. Supilnikov ◽  
E. V. Kolesnikov ◽  
A. A. Starostina ◽  
L. A. Trusova ◽  
M. S. Mikhailov ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Local Treatment ◽  
Risk Groups ◽  
Practical Experience ◽  
Scientific Data ◽  
Diabetic Foot Syndrome ◽  
Original Research ◽  
Scientific Group ◽  
Treatment Of Wounds ◽  
Medical University

The draft clinical guidelines were developed by the team of the scientific group for the treatment of wounds and wound process of the Reaviz Medical University, taking into account modern scientific data, practical experience and original research. The data on the formulation of the diagnosis in diabetic foot syndrome, the existing classification of ulcers and wounds, the survey plan, basic and additional therapy, local treatment of ulcers and wounds are presented.

Treating diabetic foot syndrome at the General Surgery Clinic of the S.M. Kirov Military Medical Academy

2021 ◽  
Vol 2 (3(5)) ◽  
pp. 20-29
Author(s):  
S.Ya. Ivanusa ◽  
◽  
B.V. Risman ◽  
A.V. Yanishevsky ◽  
R.E. Shayakhmetov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Diagnostic Algorithm ◽  
Ultrasonic Cavitation ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Physical Methods ◽  
Purulent Wounds

We examined 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the proposed diagnostic algorithm was used. Magnetic resonance imaging of the feet, ultrasound Doppler with duplex angioscanning, magnetic resonance and computed angiography of the lower extremities, as well as assessment of transcutaneous oxygen tension were performed. Surgical treatment tactics depended on the form of the diabetic foot syndrome, as well as the severity of the disease. As a local treatment, physical methods were used to accelerate the course of the wound process. The proposed diagnostic algorithm for the diagnosis and selection of surgical treatment for various forms of diabetic foot syndrome has made it possible to reduce the number of “high” amputations and maintain a supporting limb. Purpose of the study is to improve treatment outcomes for purulent-necrotic complications of diabetic foot syndrome by developing and applying a diagnostic algorithm and differentiated treatment tactics. The main group consisted of 180 patients with purulent-necrotic complications of diabetic foot syndrome, in whom the developed diagnostic algorithm and differentiated tactics of surgical treatment were used, as well as physical methods of influencing the wound process (ultrasonic cavitation and local ozonation) were used as local treatment. The control group included 40 patients with purulent-necrotic complications of diabetic foot syndrome, whose treatment involved the use of drugs that improve the rheological properties of blood and tissue microcirculation (rheopolyglucin, trental, actovegin) according to conventional schemes. Local treatment included sanitation and treatment of wound and ulcerative surfaces with antiseptic solutions and ointments, depending on the phase of the wound process. Data analysis in this group was carried out based on a retrospective study of case histories and an assessment of long-term results of treatment by follow-up examinations and telephone interviews. Control group included 25 (63%) men and 15 (37%) women; the average age was 67.3±10.3 years. The developed unified approaches in diagnosing and treating patients with purulent-necrotic complications of diabetic foot syndrome, who, in complex treatment, underwent staged necrectomy with simultaneous ultrasonic cavitation of purulent wounds and their ozonization, can reliably reduce the number of ulcer recurrences from 28% to 2.7%, high amputations by 34%, and the number of re-amputations ― 10 times. The use of minimally invasive surgical technologies for the rehabilitation of deep purulent foci of the foot, in comparison with the classical principles of treatment of purulent wounds, makes it possible to achieve a complete cleansing of wounds, preparation for plastic surgery, and an increase in the number of functional supportable lower limbs by 42.7%. According to the data obtained, it is optimal to perform sanitizing operations after revascularization of at least one artery no earlier than 3–4 days, which makes it possible to increase their efficiency and reduce the number of repeated surgical interventions. The approach to managing patients with diabetic foot syndrome at all stages of treatment and rehabilitation should be interdisciplinary and include the following specialists: endocrinologist, orthopedist, surgeon, psychologist, trained nursing staff.

scholarly journals PRESCRIPTION PATTERN AND USAGE OF ANTIMICROBIAL AGENTS FOR TREATING DIABETIC FOOT INFECTIONS AT TERTIARY CARE CENTRE

2020 ◽  
pp. 136-141
Author(s):  
DASARAJU RAJESH ◽  
M. V. ADVAITHA ◽  
RAJENDRA HOLLA
Keyword(s):  
Diabetic Foot ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Local Treatment ◽  
Tertiary Care Centre ◽  
Prescribing Pattern ◽  
Anaerobic Microorganisms ◽  
Diabetic Foot Infections ◽  
Gram Negative Organisms ◽  
Treatment Of Wounds

Objective: Due to the uncertainty about optimal antibiotic treatment, and probably substantial variation in practice, the present study was carried out to determine the bacterial profiles of infected diabetic foot ulcers (DFUs) and also to analyze the prescribing pattern of antibiotics used. Methods: A prospective observational study was carried out in the department of General surgery at a tertiary care teaching hospital, Mangalore. Demographic details and treatment data of 78 patients were collected in a specially designed Proforma, and the data were analyzed using Microsoft Excel. Results: According to Meggit-Wagner's classification, patients admitted with DFUs predominantly belonged to WAGNER 1 category (36%), followed by WAGNER 4 (26%) and WAGNER 2 (22%) categories. Out of 66 culture-positive specimens, 21 (31.8%) had monomicrobial flora, and 45 (68.2%) had polymicrobial flora. A total of 148 organisms were obtained from the specimens. The most common isolates were Staphylococcus aureus (22.3%) and Pseudomonas aeruginosa (17.5%). Ceftriaxone was the most commonly prescribed empirical antibiotic (29%), followed by linezolid (20%), piperacillin-tazobactam (20%), amoxicillin-clavulanic acid (13%), cefoperazone-sulbactam (11%). After the culture and sensitivity (C/S) results, antimicrobials were changed in 74.61% of patients in the preference of Linezolid (51%), Amikacin (27%), Levofloxacin (19%), Ciprofloxacin (17%), Piperacillin-tazobactam (13%), Cefixime (15%), Ceftriaxone (11%) among others. Clindamycin and metronidazole were used to cover anaerobic microorganisms. Conclusion: Most of the microorganisms isolated from DFUs were resistant to many types of antibiotics. Gram-positive organisms were largely sensitive to linezolid and vancomycin, while Gram-negative organisms to amikacin and imipenem. Local treatment of wounds is essential.

scholarly journals Modern approaches to local treatment of pyo-necrotic complications of the diabetic foot syndrome

2012 ◽  
Vol 93 (2) ◽  
pp. 301-303
Author(s):  
L E Slavin ◽  
B N Godzhaev ◽  
A Z Zamaleev
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Healing Process ◽  
Local Treatment ◽  
Water Soluble ◽  
Diabetic Foot Syndrome ◽  
Layered System ◽  
Second Phase ◽  
Bathing Solution ◽  
Optimal Conditions

The analysis of publications devoted to modern methods of treatment of pyo-necrotic complications of diabetic foot syndrome has been presented. Identified were the most important principles of therapeutic tactics for this type of pathology. In order to create optimal conditions for wound healing after surgical sanitation local drug treatment is carried out - a thorough wound detersion with application of the isotonic sodium chloride solution or a neutral bathing solution, periodic (as needed) necrectomies, application of bandages, in accordance with the phase of wound healing process. The choice of medication for local treatment depends on the one hand on the type of lesion of the lower limbs, on the other - on the diabetes related morbidity and phase of wound healing. In the first phase of wound healing antiseptics are used: iodophors, polyhexanide (lavasept), hydroxymethyl quinoxaline dioxide (dioxidine), and in the absence of ischemia - compositions based on gelevine, water-soluble base ointments. In the second phase used were various wound covers based on collagen, as well as oil and hydrogel dressings. Ready-to-use bandages are also used, which are multi-layered system, comprised of a cellulose substrate, collagen, fibroblasts, growth factor, coated with plates of silicon to control humidity. The disadvantage of the ready-to-use dressings is the impossibility of controlling the wound on a daily basis. One of the trends in the treatment of chronic diabetic wounds is the use of living skin cells that serve as a source of growth factors, cytokines and other proteins that stimulate the healing process. The use of local immunomodulators is seen as promising. Treatment should be individualized and systemic antibiotic therapy is required. The main principle of local treatment is the creation of optimal conditions for accelerating the healing process.

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.

CYTOLOGICAL STUDY OF THE DYNAMICS OF THE WOUND PROCESS IN PURULENT LESIONS OF THE DIABETIC FOOT SYNDROME WITH THE USE OF PROGRAMMABLE REHABILITATION TECHNOLOGIES

2021 ◽  
Vol 17 (37) ◽  
pp. 212-227
Author(s):  
Vladimir Anatolievich SERGEEV ◽  
Alexander Anatolyevich GLUKHOV ◽  
Alexander Sergeevich SOROKIN
Keyword(s):  
Diabetic Foot ◽  
Local Treatment ◽  
Diabetic Foot Syndrome ◽  
Limb Amputation ◽  
Control Group ◽  
Critical Ischemia ◽  
Results Of Treatment ◽  
Purulent Wounds ◽  
Cytological Method ◽  
Experimental Group

Background: Purulent lesions of the feet in diabetes mellitus bring excruciating suffering to the patient, reduce the quality of life and often lead to limb amputation and possible death. The disappointing results of the treatment of purulent complications of diabetes encourage the search for both new approaches to treatment and methods for assessing the reparative potential of wound defects. Aim: This study aimed to improve the treatment of purulent-necrotic complications of the diabetic foot by studying the morphological assessment of healing processes when using promising treatment methods such as then programmed debridement. Methods: Over the past 10 years, the results of treatment of 106 patients with purulent-necrotic complications of diabetic foot syndrome (DFS) without critical ischemia have been analyzed. The patients were randomized into two groups. In the experimental group (n = 55), after surgical treatment, the wound was sutured tightly, and in the postoperative period, programmed debridement was carried out using the original AMP-01 device. In the control group of patients (n = 51), the purulent wound was not sutured after the operation, and local treatment was carried out with solutions of iodophors, ointments based on polyethylene glycol. To assess the dynamics of reparative processes in purulent wounds, a cytological method was used, which makes it possible to quickly and reliably assess the stage of the wound process and the effectiveness of the treatment. The simplicity and availability of the method allows it to be recommended to all practicing specialists. Results and Discussion: In the experimental group, by day 9 after surgery, the number of degenerative forms of neutrophils in cytological smears was 2.9 times lower than in the control group - 12.3 ± 0.3% versus 36.4 ± 0.4% (p 0.001) - and the RDI indicator in experimental group was 3.4 times higher compared with the control group - 2.6 ± 0.1 and 0.9 ± 0.1, respectively (p 0.001). This indicated more active phagocytosis, more rapid cleansing of the purulent cavity. An earlier appearance of cells of young connective tissue was observed in the experimental group. The number of fibroblasts by day 9 after surgery was 4.6 times higher (6.4 ± 0.4%) than in the control group - 1.4 ± 0.1% (p 0.001), which confirmed the presence of active regenerative processes in the wound. Conclusions: The use of programmable sanitation technologies in treating purulent complications of a diabetic foot leads to a more significant reduction in the duration of the inflammation phase and acceleration of reparative processes

scholarly journals Modern approaches in treatment of diabetic foot syndrome

2020 ◽  
Vol 39 (3) ◽  
pp. 19-26
Author(s):  
Boris V. Risman ◽  
Sergey Y. Ivanusa ◽  
Andrey V. Yanishevskiy ◽  
Rauan E. Shayakhmetov
Keyword(s):  
Diabetic Foot ◽  
Local Treatment ◽  
Diagnostic Algorithm ◽  
Diabetic Foot Syndrome ◽  
Physical Methods ◽  
Modern Methods ◽  
Methods Of Treatment

The article is devoted to practical issues of the clinic, the diagnostic algorithm and tactics of treatment of purulent-necrotic complications of diabetic foot syndrome. Studying the wound process in patients with purulent-necrotic complications of diabetic foot syndrome using modern methods. The efficiency has been proved and an algorithm has been proposed for the use of some physical methods of sanitation in the local treatment of diabetic foot syndrome. The proposed methods of treatment make it possible to reduce the number of amputations and reduce mortality in patients with purulent-necrotic complications of diabetic foot syndrome (1 figure, 1 table, bibliography: 9 refs).

scholarly journals Use of Vacuum Therapy in the Treatment of Wounds in Patients with Diabetic Foot Syndrome

2016 ◽  
Vol 0 (2.74) ◽  
pp. 124 ◽  
Author(s):  
P.O. Herasymchuk ◽  
I.M. Deikalo ◽  
V.H. Vlasenko ◽  
D.B. Fira ◽  
A.V. Pavlyshyn
Keyword(s):  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Vacuum Therapy ◽  
Treatment Of Wounds

scholarly journals Clinical-functional and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome using programmable sanitation technologies

2021 ◽  
Vol 5 (3) ◽  
pp. 260-275
Author(s):  
Vladimir A. Sergeev ◽  
Alexander A. Glukhov ◽  
Alexander S. Sorokin ◽  
Sergey A. Zhuchkov ◽  
Alexander V. Gorokhov ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Diabetic Foot ◽  
Comparison Group ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Morphological Parameters ◽  
Supporting Function ◽  
Fold Reduction

Diabetes mellitus is currently characterised by a high progressive prevalence of patients. The purpose of this study is to evaluate the clinical, functional, and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome (DFS) using programmable sanitation technologies. The patients were randomised into two groups. In the comparison group (n=51), patients received conventional local treatment after surgery. In the main group (n=55), after surgical treatment, the wound was sutured, and in the postsurgical period, programmable sanitation was conducted using the AMP-01 device. The cytological smears of the main group identified a higher rate of cellular reactions in the wound. There was a 1.3-fold reduction in the duration of hospitalisation, the number of purulent complications was significantly less (p=0.014). It was possible to preserve the supporting function of the foot in patients of the main group in a larger percentage of cases (p=0.023). There was a statistically significant increase in the frequency of high amputations in the comparison group (p=0.026). As a result, the effectiveness of the use of programmable sanitation technologies for purulent lesions of the diabetic foot has been proven.

scholarly journals Vacuum therapy in complex treatment of neuropathic form of diabetic foot syndrome in Ghana

2020 ◽  
Vol 5 (3) ◽  
pp. 16-24
Author(s):  
W. M. Rdeini ◽  
V. A. Mitish ◽  
Yu. S. Paskhalova ◽  
S. L. Sokov
Keyword(s):  
West Africa ◽  
Diabetic Foot ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
City Hospital ◽  
Study Results ◽  
Antiseptic Solutions

Diabetic foot syndrome (DFS) is a serious public health problem in developing countries, where medical resources are limited, and the vast majority of patients turn to medical facilities too late with severe forms of the disease and often in advanced stages.Objective: to evaluate the effectiveness of negative pressure wound therapy (NPWT) in treating patients with a neuropathic form of DFS compared with traditional methods to reduce the number of high amputations and overall mortality in Ghana.Materials and research methods. A prospective, non-randomized, comparative clinical study of the results of examination and treatment of 59 patients with type 2 diabetes mellitus (DM) was performed at the Seventh-day Adventist City Hospital (Ghana, West Africa), Kumasi University Hospital and the Effiduase District Hospital (Ghana, West Africa) in the period from January 1, 2011 to December 31, 2013, there were 37 female patients (63.3 %), 22 male patients (36.7 %). The volume of foot tissue damage varied from II to IV degree according to Wagner classification (II degree was diagnosed in 55.6 % of cases). The average age of patients was 31.5 ± 7.3 (20–72) years. The average duration of DM was 7.3 ± 4.2 years. Bacteriological examination of wounds showed that Staphylococcus aureus was most often an isolated pathogen. All microorganisms identified from patients’ wounds had high resistance to commonly used antibiotics. Patients were randomly assigned to groups. NPWT is the only topical treatment in the main group; traditional dressings with antiseptic solutions (iodophors) were used in the comparison group.Study results. Comprehensive treatment of patients in both groups included surgical debridement of purulent foci, local treatment (NPWT or dressings with antiseptic solutions) and skin grafting or healing by secondary intention after the transition of the wound process to the reparative stage. None of the patients in both groups had a high amputation. Not a single fatal outcome has been recorded. In patients of the main group, the transition of the wound process to the reparative stage was carried out in a shorter time compared with those treated without NPWT.Conclusion. Treatment of the neuropathic form of DFS with the NPWT (for example, patients in Ghana) reduces the hospital stay and the number of high amputations of the lower extremities, and improves the quality of life of patients.

scholarly journals In honor of the 85th anniversary of Vladimir Vasilyevich Potemkin

2019 ◽  
Vol 64 (6) ◽  
pp. 412-414
Author(s):  
Elena V. Nagaeva
Keyword(s):  
Diabetic Foot ◽  
Research Work ◽  
General Medicine ◽  
Good Health ◽  
Insulin Binding ◽  
Diabetic Foot Syndrome ◽  
Clinical Aspects ◽  
Medical Institute ◽  
Results Of Treatment ◽  
Medical University

We are celebrating the 85 anniversary and 61 years of research, pedagogical and medical activities of one of the nation’s leading endocrinologists, the promoter of academic endocrinology, the founder and the first head of the department of endocrinology of the Pirogov Russian National Research Medical University (RNIMU) Honored Doctor of the Russian Federation, Professor Vladimir Vasilyevich Potemkin. V.V. Potemkin was the first in our country who began to teach endocrinology at the department of internal diseases of the pediatric faculty of the 2nd Moscow State Medical Institute (now Pirogov Russian National Research Medical University (RNIM). In 1972, after his transfer to the Department of General Medicine, V.V. Potemkin established a course of endocrinology at the chair of internal medicine. Soon, endocrinology became an independent course and on its basis a separate chair was set up. Heading first the course and then the chair for 40 years, V.V. Potemkin proved himself a talented teacher, scientist, and excellent clinicist. V.V. Potemkin is the author of 7 textbooks on various aspects of endocrinology, including the nation’s first fundamental manual Endocrinology, published, in addition to Russian, also in French, Spanish and twice in English. In his research work, V.V. Potemkin focuses on the problems of pathogenesis, clinical aspects, and treatment of diabetes and obesity. Research results obtained by V.V. Potemkin in studying the development of oxidative stress and impaired insulin-binding blood activity in patients with newly diagnosed T2D with normal body weight and suffering from obesity made it possible to find two different pathogenetic mechanisms underlying their hyperglycemia. V.V. Potemkin studied the role of cytokines in the development of diabetic foot syndrome, which led to the conclusion that the criteria for the effectiveness of treatment of patients with type 2 diabetes complicated by diabetic foot syndrome, along with normoglycemia are also decreased activity of lipid peroxidation, stabilization of antioxidant defence, normalization of the level of TNF-alpha proinflammatory cytokine. In troduction of V.V. Potemkin’s findings into clinical practice helps to improve the results of treatment of patients with diabetic foot syndrome, prevent gangrene, and reduce their direct and indirect financial costs. Professor V.V. Potemkin celebrates his anniversary at the heirght of his creative powers. We wish our dear colleague good health, inexhaustible energy, and new creative successes for many years!

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