scholarly journals Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome

2021 ◽  
Vol 8 (1) ◽  
pp. 12-23
Author(s):  
V. M. Bensman ◽  
A. G. Baryshev ◽  
S. N. Pyatakov ◽  
K. G. Triandafilov ◽  
V. N. Ponomarev ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Comparison Group ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Wound Complications ◽  
Comparison Groups

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.

scholarly journals Phototherapy in complex treatment of wounds in patients with ischemic and neuroischemic form of diabetic syndrome

2018 ◽  
Keyword(s):  
Wound Healing ◽  
Growth Factor ◽  
Diabetic Foot ◽  
Comparison Group ◽  
Local Treatment ◽  
Lower Extremities ◽  
Bone Defects ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Algorithm Analysis

The aim of the study was to improve results of wound healing in patients with ischemic and neuroischemic forms of diabetic foot syndrome by using a combination of phototherapy, platelet-derived growth factor and modern cover materials The results of surgical treatment of 48 patients with ischemic and neuroischemic diabetic foot syndrome, which were divided into main group (24 patients) and comparison group (24 patients). All these patients who underwent treatment in the Department of acute vascular diseases in the Clinic of the SI “Institute of General and Urgent Surgery named after V.T. Zaitsev of the National Academy of Sciences of Ukraine” suffered from diabetes mellitus type II and had IV degree of foot ischemia according to Fontaine. The diagnostic was performed for all patients according to a standard algorithm. Analysis of the results of clinical, laboratory, non-invasive and invasive methods of examination in the preoperative period enabled to determine the degree of disorder in blood flow, the nature of collateral circulation and microcirculation. Patients of both groups underwent femoro-tibial and femoro-popliteal bypass, as well as hybrid reconstructions. The parameters of regional hemodynamics in patients of main group and the comparison group before and after revascularization were comparable. The patients of main group used the treatment technology developed by us. In cases of development of phlegmons of the foot after the opening of the abscess, vacuum therapy was performed for 7–14 days until the wound was completely cleaned. In the preoperative preparation complex, phototherapy was performed, according to local situation, wounds were irradiated with different wavelengths (405, 470 or 525 nm). After the wounds were cleaned, the wound defect was covered with PCL coating (Nanopharma, Czech Republic) with the application of a fibrin clot and platelet-rich plasma without fibrin, after which further local treatment was accompanied by irradiation of wounds with A. Korobov-V. Korobov photon matrices “Barva-Flex” (the wavelength of the maximum of the emission band of 660 nm). In two cases, the closure of bone defects with ILAYAOSTEOGEN® “A.A. PARTNERS” L.L.C. bone implants of medical company “ilaya” was used. Using these tactics, allow to achieve complete wound healing in 91.7% of patients and partial healing (more than 50%) in 8.3% of patients in main group. The terms of treatment of these patients did not exceed 2 months, high amputations were not required. In patients of comparison group against the background of traditional local treatment, the wounds healed within 2–4 months; in eight cases, repeated hospitalization was required to perform a plastic closure; in two cases amputation was performed below the knee. Thus, phototherapy and plastic closure of wounds of the lower extremities after revascularization in isch- emic diabetic foot syndrome is indicated in cases where the wounds have no tendency to spontaneous healing; introduction of the developed tactics of treatment of “problem” wounds of the lower extremities allowed to achieve complete healing in 91.7% of patients, partial (more than 50%) healing in 8.3% of patients and avoid high amputations; the use of a complex of treatment including phototherapy, wound closure with a synthetic coating with platelet growth factor, and the closure of bone defects with implants is an extremely effective stim- ulator of development in the wound of granulation tissue suitable for further autodermoplasty

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 Photodynamic therapy of gunshot wounds soft tissue

2019 ◽  
Keyword(s):  
Photodynamic Therapy ◽  
Antibiotic Therapy ◽  
Soft Tissues ◽  
Comparison Group ◽  
Healing Process ◽  
Gunshot Wounds ◽  
Main Group ◽  
Water Soluble ◽  
Wound Healing Process ◽  
Comparison Groups

Introduction. An important component of the treatment of gunshot wounds is antibiotic therapy. Unfortunately, due to the antibiotic resistance of many strains of microorganisms, there remains a risk of purulent- infectious complications even with prolonged antibiotic therapy. In recent years, methods of physical action, in particular, photodynamic therapy (PDT), have been used to accelerate bacterial decontamination of wounds. Gunshot wounds have their own characteristics that create certain difficulties for the application of the method of photodynamic therapy. Purpose. Аnalyzes the results of the application of the developed PDT method in the complex treatment of gunshot wounds of soft tissues. Materials and methods. A comparison was made of the main indicators of the wound healing process between the wounded of the main group who used PDT (n = 52) and the comparison group (n = 32) who used treatment with complex water-soluble ointments. To increase the effectiveness of the method, the «Photolon» photosensitizer was administered in two ways: by injection infiltration of tissues around the wound and by application directly to the wound surface. The wavelength of laser radiation is 660 nm. The dose of laser energy was 20 J/cm2. Results. The results of the study showed an improvement in the course of the wound process in all respects when using PDT: the period of regression of local edema in the main group on (3.7 ± 0.4) days in the comparison group (6.2 ± 0.5), the period of wound cleansing (4.7 ± 0.6) days (7.3 ± 0.8) days, respectively; the timing of the start of granulation (4.6 ± 0.5) days and (7.8 ± 0.6). At the beginning of treatment, 45 pathogenic strains were isolated in 38 (73.1 %) wounded main groups and 26 strains in 22 (68.7 %) wounded comparison groups. A day after the use of PDT, pathogenic wound microflora was isolated in 5 (9.6 %) wounded main groups — 5 strains and 23 strains in 19 (59.4 %) wounded comparison groups. Conclusions. The effects of PDT were observed: rapid inactivation of pathogenic wound microflora, reduction of edema, pain syndrome and stimulation of granulation growth, which contributes to early closure of wounds.

scholarly journals APPLICATION OF GRAFTSKIN TO ACCELERATE HEALING OF ULCERS IN DIABETIC FOOT SYNDROME

2016 ◽  
Vol 175 (5) ◽  
pp. 63-68 ◽  
Author(s):  
M. A. Binienko ◽  
A. A. Kotslova ◽  
V. V. Davydenko ◽  
T. D. Vlasov
Keyword(s):  
Diabetic Foot ◽  
Soft Tissues ◽  
Standard Treatment ◽  
Vascular System ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Saint Petersburg ◽  
Dermal Equivalent ◽  
Method Factors

Diabetic foot syndrome (DFS) is one of the severe and more frequent complications of diabetes. It is characterized by occurrence of chronic purulent necrotic processes (trophic ulcers) on the foot with damage of skin, soft tissues and osteoarticular system due to pathological changes in the peripheral nervous system (diabetic neuropathy) and vascular system (diabetic angiopathy). This study aimed to evaluate the possibility of accelerating of wound healing in DFS by using the dermal equivalent (graftskin) and determine the safety of the method, factors and indications for its application. The research included 60 patients with DFS who were cured at the period from 2013 to 2016 in departments of purulent surgery of Hospital of war veterans and Municipal hospital № 14 of Saint-Petersburg. The patients were divided into 2 groups by random sampling of two comparable groups in age and sex. The patients of main group were treated by standard method and using application of dermal equivalent (DE) on the area of trophic ulcers. The patients of control group had only standard treatment. The DE showed a high efficacy in the main group of patients. The application of DE in complex treatment of patients with DFS stimulated processes of healing and accelerated the rate of epithelization. The application of DE was the most effective in patients with neuropathic form of DFS.

scholarly journals OPTIMIZATION OF THE VACUUM-ASSISTED TREATMENT FOR COMPLICATIONS OF DIABETIC FOOT SYNDROME

2019 ◽  
Vol 23 (5-6) ◽  
pp. 15-19
Author(s):  
V.I. Liakhovskyi ◽  
O.O. Kyzymenko ◽  
O.H. Krasnov ◽  
O.I. Krasnov ◽  
T.V. Horodova-Andrieieva
Keyword(s):  
Diabetic Foot ◽  
Topical Treatment ◽  
Comparison Group ◽  
Local Treatment ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Comprehensive Treatment ◽  
Vacuum Therapy ◽  
Second Phase ◽  
Wide Range

The nature of reparative and morphological changes in wounds was examined against the background of vacuum therapy in the comprehensive treatment of purulent and necrotic lesions of diabetic foot syndrome. We conducted comprehensive examination and treatment of 107 patients with DFS of grade II-IV according to Meggit-Wagner. The average age of patients was 53.2–4.3 years; there were 39 (36.4%) male and 68 (63.6%) female patients. Depending on the methods of topical treatment, patients were divided into two groups. The main group consisted of 55 (51.4%) subjects who underwent vacuum therapy during the topical treatment, and the comparison group comprised 52 (48.6%) patients who received standardized local treatment depending on the course of the wound process. In addition to the clinical studies, all patients underwent a comprehensive laboratory and instrumental examination, as well as measuring the area and pH of wounds on the 1st, 4th, 7th, 10th and 13th day after surgery. The analysis of the obtained results gives ground to establish that at a certain level of pH, there is a corresponding cytological pattern. The wide range of fluctuations in the pH of the wound medium in patients with purulent and necrotic lesions of diabetic foot syndrome leads to corresponding changes in cells, which is manifested by a long-lasting inflammatory process. In the main group, the rate of wound reduction was greatest on the 8th-10th days, and in the comparison group – on the 14th-15th days. Inpatient treatment was 14.2 bed-days in the main group and 23.5 ± 2.9 in the comparison group (p <0.05), respectively. Therefore, there is an acceleration of positive changes in clinical manifestations, cytological, morphological and pH-metric pattern against the background of conducting VT for an average of 5-7 days. The use of vacuum therapy makes it possible to accelerate the transition to the second phase of the wound process, which affects not only the time of treatment but also the outcome – preservation of the lower extremity in patients with diabetic foot syndrome.

scholarly journals Pathogenetic substantiation of infusion therapy using modern methods of visualization in diabetic foot syndrome

2012 ◽  
Vol 93 (2) ◽  
pp. 344-346
Author(s):  
L A Akhmetyanov ◽  
R I Fatykhov ◽  
I V Klyushkin ◽  
A E Kolesnikov ◽  
V V Naumov
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Comprehensive Evaluation ◽  
Local Treatment ◽  
Treatment Algorithm ◽  
Limb Ischemia ◽  
Diabetic Foot Syndrome ◽  
Venous Stasis ◽  
Individual Treatment ◽  
Infusion Therapy

Aim. To propose a pathogenetically substantiated infusion therapy based on the results of a comprehensive evaluation of lower limb ischemia in diabetic foot syndrome. Methods. Energetic Doppler sonography of the blood vessels of the lower extremities in its distal part and electrothermometry in 32 patients with diabetic foot syndrome and critical limb ischemia was conducted in addition to the general clinical imaging studies (radiography, ultrasonography in the «gray scale» mode). Considering the obtained data the treatment strategy in these patients (conservative or surgical) was determined together with a physician-endocrinologist. Results. Presented is an example of tactics formation for conservative infusion therapy of a patient with diabetes mellitus, which is complicated by the diabetic foot syndrome with critical limb ischemia. Compiled was an individual treatment algorithm. At the initial stage crystalloid solutions (slow drip, followed by urination stimulation) were administered. Next prescribed were vitamins from group B (cyanocobalamin 0.25 mg and pyridoxine 50 mg) in order to regulate the metabolism of key neuromediators and amino acids. The complex of treatment included the nonsteroidal anti-inflammatory drug diclofenac (25 mg). This was followed by administration of dextran solutions (reopolyglukine), in combination with an antiplatelet solution (pentoxifylline). At the final stage of therapy administered was prostaglandin E1 (alprostadil, 3-4 infusions per course). Local treatment: osmotic agents were applied to the right foot as semi-alcohol compresses to relieve swelling, improve microcirculation and promote closure of the fistulas. After the conducted treatment noted was an improvement in general condition, pain symptoms subsided, the fistula closed, the soft tissue on the foot had no signs of inflammation. Recovery of the parameters of microcirculation signify the relief of arterial and venous stasis. Conclusion. This treatment scheme will make it possible to improve the course of the disease, reduce the time of treatment and disability of patients, will also improve their quality of life.

scholarly journals Effect of negative pressure therapy on repair of soft tissues of the lower extremities in patients with neuropathic and neuroischaemic forms of diabetic foot syndrome

2014 ◽  
Vol 17 (3) ◽  
pp. 113-121
Author(s):  
Ekaterina Leonidovna Zaytseva ◽  
Ludmila Petrovna Doronina ◽  
Roman Vakhtangovich Molchkov ◽  
Iya Alexandrovna Voronkova ◽  
Valeriy Afanasievich Mitish ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Diabetic Foot ◽  
Standard Therapy ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Perioperative Period ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Negative Pressure Therapy ◽  
Pressure Therapy

Aim. To evaluate the efficiency of topical negative pressure wound therapy (NPWT) compared with standard therapy for the regeneration of the soft tissues of the lower extremities in patients with diabetic foot syndrome. Materials and Methods. The effects of negative pressure therapy on the clinical (size, tissue oxygenation), histological (light microscopy) and immunohistochemical (CD68, MMP-9, TIMP-1) aspects of repair of the soft tissue of the lower extremities in patients with diabetes mellitus were compared with those of standard treatment. Thirty-one patients with diabetic foot ulcers were included in the study from the moment of debridement until the plastic closure of the wound. During the perioperative period, 13 patients received NPWT (-90 to -120 mmHg) and 18 patients received standard therapy. Results. A reduction of the wound area (26.6%?17.2%) and the depth of the defects (40.5%?25.6%) were achieved with negative pressure therapy compared with baseline data. In the control group, the corresponding values were 25.3%?19.4% and 21.8%?21.6%, respectively. The results of transcutaneous oximetry showed a greater increase in the level of local hemodynamics in the study group (p

scholarly journals Autologous Peripheral Blood Mononuclear Cells for Limb Salvage in Diabetic Foot Patients with No-Option Critical Limb Ischemia

2021 ◽  
Vol 10 (10) ◽  
pp. 2213
Author(s):  
Alessia Scatena ◽  
Pasquale Petruzzi ◽  
Filippo Maioli ◽  
Francesca Lucaroni ◽  
Cristina Ambrosone ◽  
...  
Keyword(s):  
Peripheral Blood Mononuclear Cells ◽  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Limb Ischemia ◽  
Control Group ◽  
Peripheral Blood Mononuclear ◽  
Blood Mononuclear Cells

Peripheral blood mononuclear cells (PBMNCs) are reported to prevent major amputation and healing in no-option critical limb ischemia (NO-CLI). The aim of this study is to evaluate PBMNC treatment in comparison to standard treatment in NO-CLI patients with diabetic foot ulcers (DFUs). The study included 76 NO-CLI patients admitted to our centers because of CLI with DFUs. All patients were treated with the same standard care (control group), but 38 patients were also treated with autologous PBMNC implants. Major amputations, overall mortality, and number of healed patients were evaluated as the primary endpoint. Only 4 out 38 amputations (10.5%) were observed in the PBMNC group, while 15 out of 38 amputations (39.5%) were recorded in the control group (p = 0.0037). The Kaplan–Meier curves and the log-rank test results showed a significantly lower amputation rate in the PBMNCs group vs. the control group (p = 0.000). At two years follow-up, nearly 80% of the PBMNCs group was still alive vs. only 20% of the control group (p = 0.000). In the PBMNC group, 33 patients healed (86.6%) while only one patient healed in the control group (p = 0.000). PBMNCs showed a positive clinical outcome at two years follow-up in patients with DFUs and NO-CLI, significantly reducing the amputation rate and improving survival and wound healing. According to our study results, intramuscular and peri-lesional injection of autologous PBMNCs could prevent amputations in NO-CLI diabetic patients.

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