scholarly journals MEDICAL-SOCIAL AND ECONOMIC ISSUES IN TREATMENT OF PATIENTS WITH DIABETIC FOOT SYNDROME

2020 ◽  
pp. 42-48
Author(s):  
P. O. Gerasymchuk ◽  
D. B. Fira ◽  
A. V. Pavlyshyn
Keyword(s):  
Medical Care ◽  
Diabetic Foot ◽  
Chronic Wound ◽  
Social Issues ◽  
Diabetic Foot Syndrome ◽  
Economic Issues ◽  
Economic Problems ◽  
Results Of Treatment ◽  
Patients With Diabetes

Introduction. Аt the present stage of treatment of patients with diabetic foot syndrome can not yet be considered satisfactory, which requires further study of this problem in order to improve the provision of medical and social care to the above patients. Aim. Тo study medical, social and economic issues of providing medical care to patients with diabetic foot syndrome based on the analysis of their treatment in the Ternopil region. Matherials and Methods. The study is based on a retrospective analysis of the treatment of 1963 patients with diabetes mellitus complicated by diabetic foot syndrome during 2000–2017. Neuropathic-infected form of foot lesion was diagnosed in 692 (35.2 %) patients, ischemic-gangrenous - in 604 (30.8 %), mixed – in 667 (34 %) patients. According to the degree of lesion (according to Megitt - Wagner), the distribution of patients was as follows: II – 247 (12.6 %) patients, III – 995 (50.7 %), IV – 584 (29.7 %), V – 137 7 %) of patients. Patients with acute purulent-necrotic lesions and chronic wound defects of the lower extremities underwent surgery of various volumes: surgical debridement, small or high amputation. Results. The analysis of the obtained results allowed to note a number of social, medical and economic problems, the solution of which will significantly improve the results of treatment and in particular reduce the number of amputations in patients with diabetic foot syndrome. As the analysis shows, typical mistakes in the treatment of patients can be divided into three main groups: organizational, diagnostic and tactical. Organizational mistake lies in the fact that today in Ukraine there is no single system providing skilled care to patients with diabetic foot syndrome. The most common diagnostic mistakes include incorrect and insufficiently qualified diagnostics of clinical forms of diabetic foot syndrome and the depths of the spread of purulent-necrotic lesions of the tissues of the foot. The above mistakes significantly affected the timing and results of treatment, worsening the results of the latter. Conclusions. Based on the analysis of treatment of 1963 patients with various pathogenetic forms of the diabetic foot syndrome, a number of medical, economic and social issues have been identified that require their solution. The most typical mistakes and shortcomings in the treatment of these patients were analyzed. A program was proposed to improve the quality of specialized medical care for patients with diabetic foot syndrome.

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 The development of criteria, indices and indicators and of medical care quality for patients with syndrome of diabetic foot in out-patient practice

2019 ◽  
Vol 60 (3) ◽  
pp. 138-142
Author(s):  
Oleg V. Udovichenko ◽  
E. A. Berseneva ◽  
D. O. Meshkov
Keyword(s):  
Data Collection ◽  
Medical Care ◽  
Diabetic Foot ◽  
Care Quality ◽  
Practice Analysis ◽  
Results Of Treatment ◽  
Quality Of Structure ◽  
Chronic Course

The special techniques of evaluation of every single disease are required for assessing quality and effectiveness of treatment in out-patient practice. The purpose of study was development of criteria, indices and indicators of evaluation of quality of out-patient medical care of patients with syndrome of diabetic foot. The technique of literary searching and practice analysis were applied to develop criteria, indices and indicators for evaluating structure, processes and results of treatment. The evaluation of quality of result requires more complicated techniques of data collection as opposed to indices of quality of structure and processes. The developed indices can be also applied in evaluating effectiveness of treatment of other diseases with chronic course though curable in the main.

scholarly journals Biological Mechanisms of Chronic Wound and Diabetic Foot Healing: The Role of Collagen

2018 ◽  
Vol 19 (4) ◽  
pp. 373-382 ◽  
Author(s):  
Victor Alexandrovich Stupin ◽  
Ruslan Borisovich Gabitov ◽  
Tatiana Georgievna Sinelnikova ◽  
Ekaterina Vladimirovna Silina
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
World Literature ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Treatment Algorithm ◽  
Diabetic Foot Syndrome ◽  
Results Of Treatment ◽  
Native Collagen ◽  
Chronic Ulcers

Abstract The treatment of chronic wounds is a continuously developing research focus. The problems of excessive mechanical forces, infection, inflammation, reduced production of growth factors, and lack of collagen will affect the results of treatment. The purpose of this study was to analysse the elements that lead to long-term non-healing of chronic wounds and trophic ulcers, including diabetic foot syndrome, by determining the optimal treatment algorithm. The paper presents an analysis of the world literature on the etiopathogenesis and principles of chronic wound treatment in diabetic foot syndrome. The epidemiology of chronic wounds of different genesis is presented. The issues of physiological and metabolic disorders in chronic ulcers affecting the process of wound healing are discussed. Particular attention is paid to collagen, which is a protein that forms the basis of connective tissue; collagen ensures the strength and elasticity of the skin, which confirms the importance of its role not only in aesthetics but also in the process of wound healing. Different types of collagen and their roles in the mechanisms of chronic wound healing in diabetic foot syndrome are described. The results of clinical studies evaluating the effectiveness of medical products and preparations, consisting of collagen with preserved (native collagen) and fractionated structures, in treating chronic wounds of diabetic foot syndrome are analysed. It has been shown that the use of native collagen preparations is a promising treatment for chronic ulcers and wounds, including diabetic foot syndrome, which makes it possible to increase the effectiveness of treatment and reduce the economic costs of managing these patients.

scholarly journals Treatment, rehabilitation and assessment of the quality of life of patients operated for complications of diabetic foot syndrome

2021 ◽  
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Rehabilitation Treatment ◽  
Foot Bones ◽  
Results Of Treatment ◽  
Quality Life ◽  
Significant Difference ◽  
Rehabilitation Measures

Introduction. One of the complications of diabetes mellitus (DM) is diabetic foot syndrome (DFS), which develops in 6–11 % of patients and requires surgical treatment in 40–70 % of them. Various types of amputations and large necrectomies lead to a redistribution of the load on the foot with the development of violations of its support function and deformity. As a result, the soil arises for the development of purulent-necrotic processes, the quality of life of patients decreases. Rehabilitation is an important part of postoperative care. It should be carried out both in the hospital and at the outpatient stage of treatment and is an important measure in preventing complications and improving the quality of life of patients. Aim. To analyze the results of treatment of patients with purulent-necrotic complications (PNC) of DFS, for whom postoperative rehabilitation measures were included in the treatment complex. Materials and methods. The results of treatment of 128 patients operated on for PNC of DFS were studied. The examination and treatment were carried out according to the standards. At the outpatient stage, 45 patients underwent complex rehabilitation using a set of physical exercises in combination with physiotherapy methods of treatment. Determination of the degree of foot deformity was performed using plantography and X-ray of the foot bones. The dynamics of life quality indicators were studied using the Manchester-Oxford foot questionnaire (MOXFQ). Results and discussion. The obtained results showed that in conditions of rehabilitation treatment, after 6 months the number of complications in the main group was less than in the comparison group by 12.6 %, and after a year – by 25 %. The study of the quality of life using the MOXFQ questionnaire 6 months after rehabilitation showed a significant difference in indicators (p < 0.05) between the comparison and the main groups on pain and social interaction scales and the MOXFQ index in general, which indicates a positive effect of the used rehabilitation treatment on the quality life of patients. At the same time, after a year, the reliability of the difference in indicators on all scales and the MOXFQ-index of the main and comparison groups was not revealed, despite the best absolute figures. The result obtained indicates the need for repeated courses of rehabilitation measures in the complex of treatment. Conclusions. Treatment of patients with complications of DFS should be organ-preserving and complex. Treatment should include a set of rehabilitation measures aimed at restoring the motor function and support ability of the foot to prevent its deformation. The use of rehabilitation treatment can reduce the number of complications in the postoperative period and improve the quality of life of patients.

Diabetic foot syndrome in elderly patients

Phlebologie ◽  
2017 ◽  
Vol 46 (04) ◽  
pp. 208-208
Author(s):  
S. Eckert
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Diabetic Foot ◽  
Young Patients ◽  
Multidisciplinary Care ◽  
Well Being ◽  
Diabetic Foot Syndrome ◽  
Patients With Diabetes ◽  
Therapeutic Procedures

SummaryIn elderly patients with diabetes mellitus and mild deterioration of the lower extremities, peripheral artery disease and diabetic peripheral neuropathy may contribute to the development of a diabetic foot syndrome. Early diagnosis and intervention can help to preserve the foot and thus significantly increase quality of life with diagnostic and therapeutic procedures being the same in elderly and in young patients.Non-invasive diagnosis is possible in most bed-ridden patients and should take into account reasonable therapeutic options against the background of overall morbidity, physical performance and quality of life, which should be discussed with the patient and his relatives. Multidisciplinary care structures facilitate treatment and might lead to reduced amputation rates and an improved well-being.

scholarly journals CURRENT VIEW ON PATHOGENETIC APPROACH IN SURGICAL TREATMENT OF PATIENTS WITH DIABETIC FOOT SYNDROME

2018 ◽  
Vol 35 (1) ◽  
pp. 12-20
Author(s):  
V P Okroyan ◽  
T R Ibragimov ◽  
O V Galimov ◽  
V O Khanov
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Surgical Techniques ◽  
Diabetic Foot Syndrome ◽  
Long Term Results ◽  
Current View ◽  
Results Of Treatment ◽  
Complex Approach

Aim. To improve the immediate and long-term results of diabetic foot syndrome treatment, using modern surgical techniques. Materials and methods. The results of treatment of 264 patients were analyzed. For these patients with purulo-necrotic affection of extremities against the background of diabetes mellitus, complex treatment, including the techniques of extremity revascularization as well as modern hydrocolloid bandage materials, depending on the stage of wound process, was used; different variants of foot unloading at the clinical and ambulatory stages were offered. The method of treatment of purulo-necrotic wounds against the background of diabetes mellitus, based on differentiated use of ozonotherapy combined with application of biomaterials for closing ulcerous defects, was developed and introduced by the authors. Results. The systemic approach and criteria for choosing surgical strategy of diabetic foot syndrome treatment were worked out and presented. The immediate and long-term results of using the introduced scheme of the management of patients were studied. Conclusions. The developed complex approach is aimed at preservation of the foot and supporting function of the lower extremity; its clinical use permits to decrease the percent of amputations and lethality, improving patients’ quality of life indices.

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 Result of using a minimally invasive method of surgical treatment of purulent-necrotic complications in a patient with diabetic foot syndrome

2020 ◽  
Vol 39 (3) ◽  
pp. 60-64
Author(s):  
Sergey Y. Ivanusa ◽  
Boris V. Risman ◽  
Andrey V. Yanishevskiy
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Diabetic Foot ◽  
Pain Syndrome ◽  
Diabetic Foot Syndrome ◽  
Military Medical Academy ◽  
Results Of Treatment ◽  
Medical Academy ◽  
Invasive Method ◽  
Short Time

The article presents an analysis of the results of treatment of a patient with purulent-necrotic complications of diabetic foot syndrome, who, in the framework of surgical treatment, used a minimally invasive method of treatment of purulent-necrotic complications of diabetic foot syndrome, developed at the departments of general surgery and normal anatomy of the S.M. Kirov Military Medical Academy. The effectiveness of the developed method has been demonstrated, which makes it possible to sanitize the purulent cavity in a short time, stop pain syndrome and restore the support ability of the foot (4 figs, 1 table, bibliography: 7 refs).

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.

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