Mini-invasive revascularization operations in the complex treatment of neuroischemic and ischemic forms of diabetic foot syndrome

2021 ◽  
Vol 20 (4) ◽  
pp. 817-825
Author(s):  
Bazylbek Zhakiyev ◽  
Murat Jakanov ◽  
Bernat Zhanabaev ◽  
Anuar Koyshibaev ◽  
Samat Mukanov ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Treatment Success ◽  
Medical Science ◽  
Blood Flow Rate ◽  
Main Group ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Complex Treatment ◽  
Endovascular Interventions

Objective: Diabetic foot syndrome is the most dramatic complication of diabetes mellitus. The treatment success is impossible without improving blood circulation and the elimination of hemodynamic disorders in the affected limb.The study aim was to evaluate mini-invasive revascularization operations effectiveness on the lower limbs peripheral arteries in neuro-ischemic and ischemic diabetic foot syndrome forms. Materials and methods: The study enrolled 104 patients with purulent-necrotic complications of diabetic foot syndrome. 54 (51.9%) patients underwent stenting and balloon angioplasty (the main group). The comparison group included 50 (48.1%) patients, undergoing indirect revascularization surgeries in complex treatment. Results and discussion:After endovascular interventions, the API index increased by 47.6% (p<0.01) after 20 days compared to the admission index, the average blood flow rate increased by 1.8 times (p<0.01), and the tPo2 value improved by 67.8% (p<0.01). In the control group, the tPo2 value increased by 40.3% after 20 days, and API – by 34.4%. In the main group, the swelling disappearance in the foot wounds area was by 3.7±0.5 days faster (p<0.001), wounds purification by 4.1 days (p<0.001), granulation appearance by 3.5±0.4 days (p<0.001), wound margins infiltration disappearance happened 3.3±0.9 days earlier (p<0.001), and the wound epithelization was 2.9 days earlier (p<0.01) than in the control group patients. Conclusion: Foot support function at discharge from hospital was preserved in 94.4% of the main group and in 84% of the control group. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.817-825

scholarly journals Features of organ-saving foot amputation associated with ozone therapy, local application of autologous platelet-rich plasma and vacuum sanitization of postoperative wound in patients with ischemic-gangrenous form of diabetic foot syndrome

2021 ◽  
Vol 11 (5) ◽  
pp. 237-245
Author(s):  
V. D. Fundiur ◽  
V. K. Grodetskyi ◽  
S. O. Yakobchuk ◽  
O. Y. Khomko ◽  
I. M. Kozlovska ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Platelet Rich Plasma ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Local Application ◽  
Control Group ◽  
Ozone Therapy ◽  
Reparative Process ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

Improvement of reparative process of the chronic wounds with the insufficiency of peripheral blood suppling in patients suffering from diabetes mellitus is an important issue requiring further investigation. An optimal choice of surgery, effective renewal of blood supply and active stimulation of tissue repair on the cellular level are essential components of success treatment of this problem.Objective of research: From 2017 to 2020, the efficiency of one of the variants of organ-saving surgery performed on 210 patients with an ischemic-gangrenous form of diabetic foot syndrome was studied.Materials and methods. Control group included 104 patients (49.52%), were the treatment carried out in accordance with the standard scheme. The main group (106 patients - 50.47%) in addition to the standard therapy have used regional ozone therapy, vacuum sanitization and local application of autologous platelet-rich plasma (APRP).Results. These proposed measures reduced the period of clinical treatment to 24±1,2 days in the main group compared to 37±2,4 in the control one. 2 years later, patients of the main group confirmed the formation of a foot stump functionally adapted for walking with angular dislocation of fragments of the cuboid and scaphoid bones.Two years after foot amputation due to the ischemic-gangrenous form of diabetic foot syndrome (DFS), the amount of repeated above knee amputations was 1.8 times higher in the control group in comparison with the main group, which is indicative of a reasonable use of the complex of activate a reparative process in the wound.Conclusions: The suggested modification of the organ-saving and partial foot amputation in patients with IV degree of ischemia and DFS is indicative of a possibility to perform such kind of surgery as a variant of choice.The complex of proposed additional measures including regional ozone therapy, vacuum sanitization and local administration of autologous platelet-rich plasma activates a reparative process of a chronic foot wound and promotes an effective treatment of patients with ischemic-gangrenous form of DFS.

scholarly journals SYNDROME OF DIABETIC FOOT: MODERN APPROACHES OF COMPLEX TREATMENT

2015 ◽  
Vol 174 (5) ◽  
pp. 61-65
Author(s):  
O. V. Galimov ◽  
V. O. Khanov ◽  
R. R. Saifullin ◽  
G. R. Valieva ◽  
V. P. Okroyan
Keyword(s):  
Hospital Stay ◽  
Diabetic Foot ◽  
Middle Age ◽  
Diabetic Foot Syndrome ◽  
Complex Treatment ◽  
Endovascular Interventions ◽  
Results Of Treatment ◽  
Complex Approach ◽  
Reconstructive Operations ◽  
One Year

The article presents the results of treatment of 201 patients with neuroischemic form of diabetic foot syndrome. The research included 158 women and 43 men of the middle age of 62,5±11,2 years. The complex approach was applied in treatment includ ing medicamentous treatment, revasculization of extremity, an application of modern combined collagenous coating and foot relieving using silicone insoles and orthopedic footwear. The endovascular and open reconstructive operations were performed in order to obtain the revasculization of extremity. Given complex approach allowed reducing the terms of hospital stay, the rate of ulcerous defects recurrences and relapses of ischemia of lower extremities during one year after endovascular interventions.

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 PECULIARITIES OF PERFORMING ORGAN-SAVING AMPUTATION OF THE FOOT COMBINED WITH OZONE THERAPY, LOCAL APPLICATION OF AUTOLOGOUS PLATELET-RICH PLASMA AND VACUUM SANATION OF POSTOPERATIVE WOUND IN PATIENTS WITH ISCHEMIC-GANGRENOUS FORM OF DIABETIC FOOT SYNDROM

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
V.D. Fundiur ◽  
V.K. Grodetskyi ◽  
S.O. Yakobchuk ◽  
O.Y. Khomko ◽  
I.M. Kozlovska ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Platelet Rich Plasma ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Local Application ◽  
Control Group ◽  
Ozone Therapy ◽  
Reparative Process ◽  
Autologous Platelet Rich Plasma ◽  
Autologous Platelet

A positive result of treatment of patients suffering from ischemic-gangrenous form ofdiabetic foot syndrome (DFS) becomes possible with an optimal choice of surgery,effective renewal of blood supply and active stimulation of tissue restoration processon the cellular level.Objective – to study efficiency of the suggested organ-saving variant of surgery combinedwith the use of a complex of auxiliary factors of a reparative process activation in thewound including regional ozone therapy, vacuum sanitation and local application ofautologous platelet-rich plasma (PRP).Material and methods. The treatment of 210 patients with ischemic-gangrenous formof diabetic foot syndrome was carried out from 2017 to 2020. The efficiency of one ofthe variants of organ-saving operative intervention was studied. In the control group -104 (49.52%), the treatment was carried out in accordance with the standard scheme.In the main group (106 patients - 50.47%), in addition to the standard scheme, regionalozone therapy, vacuum sanitation and local application of autologous-rich plasma(PRP) were carried out.Results. These measures reduced the period of treatment of patients in the hospital to24 ± 1.2 days in the main group compared to 37 ± 2, 4 in the control one. 2 years later, patients of the main group confirmed the formation of a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones.Conclusions. The suggested modification of the organ-saving and partial foot amputationin patients with IV degree of ischemia and DFS is indicative of a possibility to performsuch kind of surgery as a variant of choice for patients with ischemic-gangrenousform of diabetic foot syndrome. The complex of auxiliary measures (regional ozonetherapy, vacuum sanitation and local administration of autologous platelet-rich plasma(APRP)), activates a reparative process of healing of a chronic foot wound whichenables to make the period of hospital staying for patients shorter – to 24±1,2 days inthe main group as compared to 37±2,4 days in the control one. Clinical observation ofa remote postoperative period (2 years later) confirms a possibility to form a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones, functionally advantageous for supporting load.

Clinical efficacy of osteopathic correction in the complex treatment of patients with unoperated open-angle glaucoma

2020 ◽  
pp. 97-105
Author(s):  
E. N. Simakova ◽  
O. V. Stenkova
Keyword(s):  
Intraocular Pressure ◽  
Drug Therapy ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Randomized Study ◽  
Main Group ◽  
Control Group ◽  
Open Angle ◽  
Complex Treatment ◽  
Hypotensive Drug

Introduction. Glaucoma is one of the most significant eye diseases. It is often diagnosed, not always amenable to therapy, and can lead to a complete loss of visual functions. In recent years, the method of osteopathic correction has become widespread as one of the effective methods of treatment and rehabilitation of patients with pathologies of various body systems. In the pathogenesis of glaucoma, it is customary to distinguish a dystrophic concept, which considers primary open-angle glaucoma as a result of dystrophic changes in the connective tissue, as well as in the endothelial lining of the trabeculae and Schlemm′s canal, especially destructive changes in mitochondria and the alteration of their functional activity. A vascular concept is also distinguished. According to this concept, the central link in the pathogenesis of glaucoma is circulatory disorder in the ciliary vessels, ocular artery, and major vessels of the head and neck, it can be assumed that osteopathic correction in the treatment of patients with open-angle glaucoma will be pathogenetically substantiated and will have a positive effect on intraocular pressure and trophicity of the optic nerve. The goal of research — to study the influence of in osteopathic correction on the nature of unoperated glaucoma (stage IIA) and to substantiate the possibility of using osteopathic correction in the complex treatment of patients with this pathology.Materials and methods. A prospective controlled randomized study was conducted at 52 city polyclinics, branch 3, Moscow, from January 2018 to January 2019. 40 patients (70 eyes) aged 50 to 75 years with primary open-angle glaucoma IIA stage were examined. At this stage of the disease, patients most often seek medical care and the issue of conservative management is primarily considered. All patients were divided into two groups of 20 people: the main group and the control group. The treatment in the main group included hypotensive drug therapy and osteopathic correction. Patients of the control group received only drug therapy. All patients underwent ophthalmic (visometry, tonometry, perimetry) and osteopathic examination twice: before the treatment and after 3 months.Results. For patients with primary open-angle IIA non-operated glaucoma, regional (most often regions of the head, neck, dura mater) and local (abdominal diaphragm, iliac bones, hip and knee joints) somatic dysfunctions were the most typical. In the main group a statistically significant decrease in the frequency and severity of dysfunctions at all levels was stated. Also, in patients receiving osteopathic correction, a significant decrease in the level of intraocular pressure and perimetric indices was noted. In patients of the control group, no reliable changes in these indicators were obtained.Conclusion. The results obtained indicate that osteopathic correction is clinically effective in the complex treatment of patients with primary open-angle II A glaucoma.

scholarly journals Treatment of the diabetic foot infections in septic surgery unit of the municipal versatile hospital

2015 ◽  
Vol 14 (1) ◽  
pp. 60-66
Author(s):  
A. A. Protasov ◽  
N. A. Bubnova ◽  
M. A. Shatil ◽  
A. S. Soloveichik ◽  
K. S. Suprun ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Volume Flow ◽  
Diabetic Foot Syndrome ◽  
Complex Treatment ◽  
Peripheral Speed ◽  
Diabetic Foot Infections ◽  
Complex Therapy ◽  
Popliteal Block ◽  
Surgical Unit

Experience of surgical and complex treatment more than 2500 patients with the purulent and necrotic complications of various forms of a diabetic foot syndrome was generalized. The number of such patients in our unit for the last fifth anniversary in comparison with previous years was doubled. At an ischemic form vasodilating complex therapy was carried out. At the femoral and popliteal block with a limited distal necrosis autovenous shunting with the subsequent economical necretomy was carried out, without sending of the patient from the septic surgical unit. In a case of the neuropathic form of a diabetic foot syndrome drainage of suppurative focuses, economical and sometimes repeated necretomies at various levels of the foot was made. It allowed us to keep foot of the patient for an extremity support in 80 % of the all cases. Frequency of high amputations in recent years was reduced, at the level of a femur from 13 to 1.4 %, at the level of a shin - from 11.5 to 5.8 %. In diagnostics, operation scoping and an assessment of effectiveness of treatment, researches of microcirculation by means of the device «Minimax-Doppler-К» were used. When the indexes of the peripheral speed of a linear bloodflow more than 1.6 mm/sec and rate of volume flow more than 0.0128 ml/min reamputation was not required.

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.

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.

Complex treatment of patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome

2020 ◽  
pp. 81
Author(s):  
B.M. Belik ◽  
I.P. Chumburidze ◽  
M.Yu. Shtilman ◽  
O.A. Yavruyan ◽  
Yu.P. Savchenko
Keyword(s):  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Complex Treatment

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%.

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